Manipulatable surgical systems with selectively articulatable fastening device

ABSTRACT

Devices and systems are provided for controlling movement of a working end of a surgical device by means of a robotic system. In one embodiment, systems and devices are provided for moving an end effector on a distal end of a surgical fastening device. Movement can include rotational movement of the end effector about an axis of the shaft, articulation of the end effector relative to the shaft, and actuation of an end effector, e.g., closing, firing, and/or cutting.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 13/369,594, entitledROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT WITH SELECTIVELYARTICULATABLE END EFFECTOR, filed Feb. 9, 2012, which issued on Apr. 5,2016 as U.S. Pat. No. 9,301,759, which is a continuation applicationclaiming priority under 35 U.S.C. § 120 to U.S. patent application Ser.No. 13/118,194, entitled ROBOTICALLY-CONTROLLED ENDOSCOPIC ACCESSORYCHANNEL, filed May 27, 2011, which issued on Mar. 31, 2015 as U.S. Pat.No. 8,992,422, which is a continuation-in-part application claimingpriority under 35 U.S.C. § 120 to U.S. patent application Ser. No.11/277,324, entitled ARTICULATING ENDOSCOPIC ACCESSORY CHANNEL, filedMar. 23, 2006, now U.S. Patent Application Publication No. US2007/0225562, the entire disclosures of which are hereby incorporated byreference herein.

FIELD OF THE INVENTION

The present invention relates broadly to methods and devices forcontrolling movement of a working end of a surgical device.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferred over traditionalopen surgical devices since the use of a natural orifice tends to reducethe post-operative recovery time and complications. Consequently,significant development has gone into a range of endoscopic surgicalinstruments that are suitable for precise placement of a working end ofa tool at a desired surgical site through a natural orifice. These toolscan be used to engage and/or treat tissue in a number of ways to achievea diagnostic or therapeutic effect.

Endoscopic surgery requires that the shaft of the device be flexiblewhile still allowing the working end to be articulated to angularlyorient the working end relative to the tissue, and in some cases to beactuated to fire or otherwise effect movement of the working end.Integration of the controls for articulating and actuating a working endof an endoscopic device tend to be complicated by the use of a flexibleshaft and by the size constraints of an endoscopic instrument.Generally, the control motions are all transferred through the shaft aslongitudinal translations, which can interfere with the flexibility ofthe shaft. There is also a desire to lower the force necessary toarticulate and/or actuate the working end to a level that all or a greatmajority of surgeons can handle. One known solution to lower theforce-to-fire is to use electrical motors. However, surgeons typicallyprefer to experience feedback from the working end to assure properoperation of the end effector. The user-feedback effects are notsuitably realizable in present motor-driven devices.

Accordingly, there remains a need for improved methods and devices forcontrolling movement of a working end of an endoscopic surgical device.

SUMMARY OF THE INVENTION

In one embodiment, a surgical device is provided having an elongateshaft with a proximal end having a handle movably coupled thereto, and adistal end having a flexible neck extending therefrom. The handle andthe flexible neck can be operatively associated such that movement ofthe handle is effective to cause the flexible neck to articulate inmultiple planes. In certain exemplary embodiments, movement of thehandle can be mimicked by the flexible neck. The device can also includean actuator extending between the handle and the flexible neck andconfigured to transfer movement from the handle to the flexible neck.

The handle of the device can have a variety of configurations, but inone embodiment the handle can be adapted to articulate relative to theproximal end of the elongate shaft. For example, the handle can becoupled to the proximal end of the elongate shaft by a joint, such as aball and socket joint, a hinge joint, or a flexing joint. The actuatorof the device can also have a variety of configurations, and in oneembodiment the actuator can be at least one cable extending along alength of the elongate shaft. For example, the device can include aplurality of cables extending along a length of the shaft and equallyspaced apart from one another around a circumference of the actuator.The cables are configured to slide relative to an axis of the elongateshaft and to apply tension to the elongate shaft to cause at least aportion of the elongate shaft to flex and bend. The handle and/or thecables can also optionally include a locking mechanism associatedtherewith and configured to maintain the handle and/or cables in a fixedposition. In an exemplary embodiment, the elongate shaft is configuredto passively flex and bend when it is inserted through a tortuous lumen.

The elongate shaft can also have a variety of configurations, but in oneembodiment the device can be in the form of a surgical stapler and theelongate shaft can include an end effector coupled to a distal end ofthe flexible neck and adapted to engage tissue and deliver at least onefastener into the engaged tissue. The handle and the end effector can becoupled such that movement of the handle is mimicked by the endeffector. For example, the handle can be coupled to the proximal end ofthe elongate shaft by a joint, such as a ball and socket joint, a hingejoint, and a flexing joint, and the flexible neck can be formed on orcoupled to the end effector to allow the end effector to proportionallymimic movement of the handle. The device can also include an actuatorextending between the handle and the end effector and configured totransfer movement from the handle to the flexible neck. The actuator canbe, for example, a plurality of cables extending along a length of theelongate shaft. The cables can be equally spaced apart from one anotheraround a circumference of the elongate shaft.

In another embodiment, the device can be in the form of an accessorychannel and the elongate shaft can be in the form of a tube having aninner lumen adapted to receive a tool therethrough. The flexible neckextending from the distal end of the elongate tube can be configured toflex to orient a tool extending through the elongate tube. The flexibleneck can have a variety of configurations, but in one embodiment itincludes a plurality of slits formed therein to facilitate flexionthereof. The slits can be configured to cause the flexible neck to flexinto a desired orientation. For example, the flexible neck can include adistal region of slits and a proximal region of slits, and the slits canbe configured such that tension applied to the flexible neck will causethe flexible neck to bend at the proximal and distal regions. A handlecan be coupled to the proximal end of the elongate tube, and it canoperatively associate with the flexible neck such that movement of thehandle is mimicked by the flexible neck. The handle can also have avariety of configurations, and in one embodiment the handle can includea stationary member and a movable member adapted to articulate relativeto the stationary member. The movable member can be coupled to thestationary member by a joint, such as a ball and socket joint, a hingejoint, and a flexing joint. In use, the accessory channel can beconfigured to releasably attach to an endoscope. For example, a matingelement can be formed on and extend along a length of an externalsurface thereof for mating to a complementary mating element formed on asleeve adapted to receive an endoscope. The device can also include anactuator extending between the handle and the flexible neck. Theactuator can be configured to transfer movement from the handle to theflexible neck. In certain exemplary embodiments, the actuator is in theform of at least one cable extending along a length of the elongatetube. Where the actuator includes multiple cables, the cables arepreferably equally spaced apart from one another around a circumferenceof the elongate tube. The cables can extend along the elongate tubeusing various techniques. For example, the elongate tube can include atleast one lumen formed in a sidewall thereof and extending along thelength thereof, and the cable(s) can be slidably disposed within thelumen(s). The device can also include a locking mechanism positioned toengage at least one of the handle and the cable(s) to lock the handleand the cable(s) in a fixed position.

The present invention also provides an endoscopic system having anelongate sleeve configured to be disposed around an endoscope, and anaccessory channel removably matable to the elongate sleeve. Theaccessory channel can have an inner lumen extending therethrough betweenproximal and distal ends thereof for receiving a tool, a flexibleportion formed on a distal portion thereof and being made flexible by aplurality of slits formed therein, and at least one handle coupled tothe proximal end thereof and operatively associated with the flexibleportion such that the handle(s) is configured to cause the flexibleportion to articulate in at least one plane. The handle(s) can beoperatively associated with the flexible portion by at least one cable,and the handle(s) can be configured to axially move the cable(s)relative to the accessory channel to cause the cable(s) to apply tensionto the flexible portion of the accessory channel such that the flexibleportion articulates in at least one plane. In one embodiment, the devicecan include a single handle configured to cause the flexible portion toarticulate in multiple planes. The single handle can include astationary member coupled to the proximal end of the accessory channel,and a movable member configured to articulate relative to the stationarymember. The single handle and the flexible portion can be operativelyassociated such that movement of the single handle is mimicked by theflexible portion. In another embodiment, the handle can include a firstmember configured to cause the flexible portion to articulate in a firstplane, and a second member configured to cause the flexible portion toarticulate in a second plane. In particular, the handle can include astationary member coupled to the proximal end of the accessory channel,and the first and second members can be rotatably coupled to thestationary member. The device can further include a first spool coupledto the first member and having at least one cable extending therefromand coupled to the flexible portion, and a second spool coupled to thesecond member and having at least one cable extending therefrom andcoupled to the flexible portion. The first and second members can beeffective to rotate the first and second spools and thereby move thecables axially to cause the flexible portion to articulate.

The surgical devices disclosed herein can also include a variety ofother features. For example, the device can include an optical imagegathering unit disposed on a distal end of the elongate shaft. Theoptical image gathering unit can be adapted to acquire images duringendoscopic procedures. An image display screen can be disposed on aproximal portion of the device and adapted to communicate with theoptical image gathering unit to display the acquired images. In otherembodiments, the end effector of the device can include a cartridgeremovably disposed therein and containing a plurality of staples forstapling tissue and a blade for cutting stapled tissue.

In other aspects, a surgical method is provided and includes insertingan elongate shaft into a body lumen to position a flexible neck coupledto a distal end of the elongate shaft adjacent to tissue to be treated,and moving a handle pivotally coupled to a proximal end of the elongateshaft to cause the flexible neck to mimic the motion of the handle. Theflexible neck can mirror movement of the handle, or movement of theflexible neck can directly correspond to movement of the handle. Incertain exemplary embodiments, the movement is proportional.

In one exemplary embodiment, an end effector coupled to a distal end ofthe elongate shaft is positioned adjacent to tissue to be fastened, anda handle pivotally coupled to a proximal end of the elongate shaft ismoved to cause the end effector to proportionally mimic the motion ofthe handle. The end effector can mirror movement of the handle, ormovement of the end effector can directly correspond to movement of thehandle. In an exemplary embodiment, the handle is pivotally articulatedabout the proximal end of the elongate shaft to cause the end effectorto mimic the motion of the handle. The method can further includeengaging tissue between opposed jaws of the end effector, and driving atleast one fastener from the end effector into the tissue. Tissue can beengaging by moving a translating member formed on the handle from afirst position to a second position to close the opposed jaws, and thefasteners can be fired by rotating a rotatable member formed on thehandle to actuate a driver mechanism disposed within the end effector tocause the driver mechanism to drive a plurality of fasteners into thetissue. In another embodiment, prior to moving the translating memberfrom the first position to the second position, the rotatable member canbe rotated to rotate the end effector relative to the flexible neckwithout actuating the driver mechanism.

In yet another aspect, the elongate shaft can be in the form of anaccessory channel that is slidably mated to an endoscope disposed withina body cavity to position a distal end of the accessory channel inproximity to a distal end of the endoscope. A tool is inserted through alumen in the accessory channel such that the tool extends distallybeyond the distal end of the accessory channel, and a handle coupled toa proximal end of the accessory channel can be moved to cause a flexibleneck on the distal end of the accessory channel to articulate, therebycausing a working end of the tool to be oriented in a desired position.The handle can be moved by pivotally articulating the handle relative tothe accessory channel, or alternatively is can be moved by rotating atleast one rotatable member on the handle.

In accordance with other general aspects of the various embodiments ofthe present invention, there is provided a surgical device that includesan end effector that is configured to perform at least one surgicalprocedure in response to at least one control motion applied theretofrom a control unit of a robotic system. An elongate shaft is coupled tothe end effector and is configured to facilitate the transmission of atleast one control motion to the end effector from the robotic system.The elongate shaft defines a shaft axis and is configured to facilitatearticulation of the end effector in two planes that are substantiallyperpendicular to the shaft axis upon manipulation of the control unitrelative to the elongate shaft such that movement of the control unit ismimicked by the end effector.

In accordance with still other general aspects of various embodiments ofthe present invention, there is provided an accessory channel forreleasable attachment to an endoscope. In various embodiments, theaccessory channel comprises an elongate tube that has an inner lumenextending therethrough between proximal and distal ends thereof forreceiving a tool. The accessory channel further comprises a flexibleneck that extends from the distal end of the elongate tube and isconfigured to flex to orient a tool extending through the elongate tube.The flexible neck is configured to be operably coupled to at least aportion of a robotic system such that movement of the at least a portionof the robotic system is mimicked by the flexible neck.

In accordance with still other general aspects of various embodiments ofthe present invention, there is provided an endoscopic system for usewith a robotic system. In various forms, the endoscopic system comprisesan elongate sleeve that is configured to be disposed around anendoscope. An accessory channel is removably matable to the elongatesleeve. The accessory channel has an inner lumen extending therethroughbetween proximal and distal ends thereof for receiving a tool. Aflexible portion is formed on a distal portion thereof and is madeflexible by a plurality of slits formed therein. The proximal end of theaccessory channel is configured for operable attachment to at least aportion of the robotic system such that actuation of the at least aportion of the robotic system causes the flexible portion to articulatein at least one plane.

In various embodiments, a surgical system is disclosed. The surgicalsystem comprises a first rotary output member, a second rotary outputmember, a third rotary output member, and a surgical end effector. Thesurgical end effector comprises a first jaw and a second jaw. One of thefirst and second jaws is movable relative to the other of the first andsecond jaws between open and closed positions upon application of jawcontrol motions thereto. One of the first and second jaws comprises asurgical staple cartridge. The surgical end effector further comprises afiring member axially movable between a starting position and an endingposition within the first and second jaws. The firing member isconfigured to axially pass through the first and second jaws to ejectsurgical staples housed within the surgical staple cartridge. Thesurgical system further comprises an elongate shaft assembly defining alongitudinal tool axis and operably coupled to the surgical end effectorto facilitate selective articulation of the surgical end effectorrelative to the longitudinal tool axis. The elongate shaft assemblycomprises a plurality of articulation members movably supported by theelongate shaft assembly and operably interfacing with the surgical endeffector. The elongate shaft assembly further comprises a firing shaftoperably interfacing with the firing member to apply a firing motionthereto. The surgical system further comprises an articulationtransmission operably interfacing with the first rotary output memberand the plurality of articulation members such that rotation of thefirst rotary output member applies articulation motions to the pluralityof articulation members. The surgical system further comprises a firingdrive member operably coupled to the firing shaft and being configuredto interface with the second rotary output member to apply firingcontrol motion to the firing shaft. The surgical system furthercomprises a closure clutch assembly operably interfacing with theelongate shaft assembly and the third rotary output member to receive athird rotary output motion therefrom to thereby selectively axiallyadvance at least a portion of the elongate shaft assembly along thelongitudinal tool axis to apply the jaw control motions to at least oneof the first and second jaws.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is a perspective view of one embodiment of a surgical staplingand cutting device, showing a working end of the device in an initialposition;

FIG. 1B is a perspective view of the surgical stapling and cuttingdevice of FIG. 1A, showing the working end of the device in anarticulated position;

FIG. 2 is a perspective view of a portion of a flexible neck of thedevice shown in FIGS. 1A and 1B;

FIG. 3A is a perspective view of a distal portion of the device shown inFIGS. 1A and 1B, showing an end effector and the flexible neck of FIG. 2coupled thereto;

FIG. 3B is a cross-sectional view taken across line 3B-3B of the endeffector shown in FIG. 3A;

FIG. 4A is a perspective view of a proximal portion of the device shownin FIGS. 1A and 1B, showing a handle movably coupled to a proximal endof a shaft of the device;

FIG. 4B is an exploded view of the proximal portion of the device shownin FIG. 4A;

FIG. 5 is a perspective view of coupling element disposed between theflexible neck and elongate shaft of the device shown in FIGS. 1A and 1B,showing an optical image gathering apparatus;

FIG. 6 is a perspective view of the handle of the device shown in FIGS.1A and 1B, showing an image display screen;

FIG. 7 is a perspective view of an accessory channel for use with anendoscope;

FIG. 8A is a perspective view of a flexible neck of the device shown inFIG. 7;

FIG. 8B is a perspective view of the flexible neck shown in FIG. 8A,showing the neck articulated in a first direction;

FIG. 8C is a perspective view of the flexible neck shown in FIG. 8A,showing the neck articulated in a second direction;

FIG. 9A is a perspective view of another embodiment of a flexible neckfor use with an accessory channel;

FIG. 9B is a perspective view of the flexible neck shown in FIG. 9A,showing the neck articulated in a first direction;

FIG. 9C is a perspective view of the flexible neck shown in FIG. 9A,showing the neck articulated in a second direction;

FIG. 10 is a perspective view of a plurality of cable actuators for usewith the device of FIG. 7;

FIG. 11 is a cross-sectional view of a shaft of the accessory channel ofFIG. 7;

FIG. 12 is a perspective view of one embodiment of an end cap for usewith the accessory channel of FIG. 7;

FIG. 13A is an exploded view of the handle and a proximal portion of theelongate shaft of the device shown in FIG. 7;

FIG. 13B is a cross-sectional view of the handle and the proximalportion of the elongate shaft of FIG. 13A in an assembled configuration;

FIG. 14A is a perspective view of another embodiment of an accessorychannel;

FIG. 14B is a cross-sectional view of the accessory channel shown inFIG. 14A;

FIG. 15A is a side view of a handle assembly of the device shown inFIGS. 14A and 14B;

FIG. 15B is an exploded view of the handle assembly of FIG. 15A;

FIG. 16A is a perspective view of one embodiment of a locking mechanism;

FIG. 16B is a perspective view of the locking mechanism of FIG. 16Acoupled to the surgical stapling and cutting device of FIGS. 1A and 1B;

FIG. 17 is a perspective view of one robotic controller embodiment;

FIG. 18 is a perspective view of one robotic surgical armcart/manipulator of a robotic system operably supporting a plurality ofsurgical tool embodiments of the present invention;

FIG. 19 is a side view of the robotic surgical arm cart/manipulatordepicted in FIG. 18;

FIG. 20 is a perspective view of an exemplary cart structure withpositioning linkages for operably supporting robotic manipulators thatmay be used with various surgical tool embodiments of the presentinvention;

FIG. 21 is a perspective view of a surgical tool embodiment of thepresent invention;

FIG. 22 is an exploded assembly view of an adapter and tool holderarrangement for attaching various surgical tool embodiments to a roboticsystem;

FIG. 23 is a side view of the adapter shown in FIG. 22;

FIG. 24 is a bottom view of the adapter shown in FIG. 22;

FIG. 25 is a top view of the adapter of FIGS. 22 and 23;

FIG. 26 is a partial bottom perspective view of the surgical toolembodiment of FIG. 21;

FIG. 27 is a partial exploded view of a portion of an articulatablesurgical end effector embodiment of the present invention;

FIG. 28 is a perspective view of the surgical tool embodiment of FIG. 26with the tool mounting housing removed;

FIG. 29 is a rear perspective view of the surgical tool embodiment ofFIG. 26 with the tool mounting housing removed;

FIG. 30 is a front perspective view of the surgical tool embodiment ofFIG. 26 with the tool mounting housing removed;

FIG. 31 is a partial exploded perspective view of the surgical toolembodiment of FIG. 30;

FIG. 32 is a partial cross-sectional side view of the surgical toolembodiment of FIG. 26;

FIG. 33 is an enlarged cross-sectional view of a portion of the surgicaltool depicted in FIG. 32;

FIG. 34 is an exploded perspective view of a portion of the toolmounting portion of the surgical tool embodiment depicted in FIG. 26;

FIG. 35 is an enlarged exploded perspective view of a portion of thetool mounting portion of FIG. 34;

FIG. 36 is a partial cross-sectional view of a portion of the elongatedshaft assembly of the surgical tool of FIG. 26;

FIG. 37 is a side view of a half portion of a closure nut embodiment ofa surgical tool embodiment of the present invention;

FIG. 38 is a perspective view of another surgical tool embodiment of thepresent invention;

FIG. 39 is a cross-sectional side view of a portion of the surgical endeffector and elongated shaft assembly of the surgical tool embodiment ofFIG. 38 with the anvil in the open position and the closure clutchassembly in a neutral position;

FIG. 40 is another cross-sectional side view of the surgical endeffector and elongated shaft assembly shown in FIG. 39 with the clutchassembly engaged in a closure position;

FIG. 41 is another cross-sectional side view of the surgical endeffector and elongated shaft assembly shown in FIG. 39 with the clutchassembly engaged in a firing position;

FIG. 42 is a top view of a portion of a tool mounting portion embodimentof the present invention;

FIG. 43 is a perspective view of another surgical tool embodiment of thepresent invention;

FIG. 44 is a cross-sectional side view of a portion of the surgical endeffector and elongated shaft assembly of the surgical tool embodiment ofFIG. 43 with the anvil in the open position;

FIG. 45 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 43 with the anvil in the closed position;

FIG. 46 is a perspective view of a closure drive nut and portion of aknife bar embodiment of the present invention;

FIG. 47 is a top view of another tool mounting portion embodiment of thepresent invention;

FIG. 48 is a perspective view of another surgical tool embodiment of thepresent invention;

FIG. 49 is a cross-sectional side view of a portion of the surgical endeffector and elongated shaft assembly of the surgical tool embodiment ofFIG. 48 with the anvil in the open position;

FIG. 50 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 49 with the anvil in the closed position;

FIG. 51 is a cross-sectional view of a mounting collar embodiment of asurgical tool embodiment of the present invention showing the knife barand distal end portion of the closure drive shaft;

FIG. 52 is a cross-sectional view of the mounting collar embodiment ofFIG. 51;

FIG. 53 is a top view of another tool mounting portion embodiment ofanother surgical tool embodiment of the present invention;

FIG. 53A is an exploded perspective view of a portion of a geararrangement of another surgical tool embodiment of the presentinvention;

FIG. 53B is a cross-sectional perspective view of the gear arrangementshown in FIG. 53A;

FIG. 54 is a cross-sectional side view of a portion of a surgical endeffector and elongated shaft assembly of another surgical toolembodiment of the present invention employing a pressure sensorarrangement with the anvil in the open position;

FIG. 55 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 54 with the anvil in the closed position;

FIG. 56 is a side view of a portion of another surgical tool embodimentof the present invention in relation to a tool holder portion of arobotic system with some of the components thereof shown incross-section;

FIG. 57 is a side view of a portion of another surgical tool embodimentof the present invention in relation to a tool holder portion of arobotic system with some of the components thereof shown incross-section;

FIG. 58 is a side view of a portion of another surgical tool embodimentof the present invention with some of the components thereof shown incross-section;

FIG. 59 is a side view of a portion of another surgical end effectorembodiment of a portion of a surgical tool embodiment of the presentinvention with some components thereof shown in cross-section;

FIG. 60 is a side view of a portion of another surgical end effectorembodiment of a portion of a surgical tool embodiment of the presentinvention with some components thereof shown in cross-section;

FIG. 61 is a side view of a portion of another surgical end effectorembodiment of a portion of a surgical tool embodiment of the presentinvention with some components thereof shown in cross-section;

FIG. 62 is an enlarged cross-sectional view of a portion of the endeffector of FIG. 61;

FIG. 63 is another cross-sectional view of a portion of the end effectorof FIGS. 61 and 62;

FIG. 64 is a cross-sectional side view of a portion of a surgical endeffector and elongated shaft assembly of another surgical toolembodiment of the present invention with the anvil in the open position;

FIG. 65 is an enlarged cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 64;

FIG. 66 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of FIGS. 64 and 65with the anvil thereof in the closed position;

FIG. 67 is an enlarged cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIGS. 64-66;

FIG. 68 is a top view of a tool mounting portion embodiment of asurgical tool embodiment of the present invention;

FIG. 69 is a perspective assembly view of another surgical toolembodiment of the present invention;

FIG. 70 is a front perspective view of a disposable loading unitarrangement that may be employed with various surgical tool embodimentsof the present invention;

FIG. 71 is a rear perspective view of the disposable loading unit ofFIG. 70;

FIG. 72 is a bottom perspective view of the disposable loading unit ofFIGS. 70 and 71;

FIG. 73 is a bottom perspective view of another disposable loading unitembodiment that may be employed with various surgical tool embodimentsof the present invention;

FIG. 74 is an exploded perspective view of a mounting portion of adisposable loading unit depicted in FIGS. 70-72;

FIG. 75 is a perspective view of a portion of a disposable loading unitand an elongated shaft assembly embodiment of a surgical tool embodimentof the present invention with the disposable loading unit in a firstposition;

FIG. 76 is another perspective view of a portion of the disposableloading unit and elongated shaft assembly of FIG. 75 with the disposableloading unit in a second position;

FIG. 77 is a cross-sectional view of a portion of the disposable loadingunit and elongated shaft assembly embodiment depicted in FIGS. 75 and76;

FIG. 78 is another cross-sectional view of the disposable loading unitand elongated shaft assembly embodiment depicted in FIGS. 75-77;

FIG. 79 is a partial exploded perspective view of a portion of anotherdisposable loading unit embodiment and an elongated shaft assemblyembodiment of a surgical tool embodiment of the present invention;

FIG. 80 is a partial exploded perspective view of a portion of anotherdisposable loading unit embodiment and an elongated shaft assemblyembodiment of a surgical tool embodiment of the present invention;

FIG. 81 is another partial exploded perspective view of the disposableloading unit embodiment and an elongated shaft assembly embodiment ofFIG. 80;

FIG. 82 is a top view of another tool mounting portion embodiment of asurgical tool embodiment of the present invention;

FIG. 83 is a side view of another surgical tool embodiment of thepresent invention with some of the components thereof shown incross-section and in relation to a robotic tool holder of a roboticsystem;

FIG. 84 is an exploded assembly view of a surgical end effectorembodiment that may be used in connection with various surgical toolembodiments of the present invention;

FIG. 85 is a side view of a portion of a cable-driven system for drivinga cutting instrument employed in various surgical end effectorembodiments of the present invention;

FIG. 86 is a top view of the cable-driven system and cutting instrumentof FIG. 85;

FIG. 87 is a top view of a cable drive transmission embodiment of thepresent invention in a closure position;

FIG. 88 is another top view of the cable drive transmission embodimentof FIG. 87 in a neutral position;

FIG. 89 is another top view of the cable drive transmission embodimentof FIGS. 87 and 88 in a firing position;

FIG. 90 is a perspective view of the cable drive transmission embodimentin the position depicted in FIG. 87;

FIG. 91 is a perspective view of the cable drive transmission embodimentin the position depicted in FIG. 88;

FIG. 92 is a perspective view of the cable drive transmission embodimentin the position depicted in FIG. 89;

FIG. 93 is a perspective view of another surgical tool embodiment of thepresent invention;

FIG. 94 is a side view of a portion of another cable-driven systemembodiment for driving a cutting instrument employed in various surgicalend effector embodiments of the present invention;

FIG. 95 is a top view of the cable-driven system embodiment of FIG. 94;

FIG. 96 is a top view of a tool mounting portion embodiment of anothersurgical tool embodiment of the present invention;

FIG. 97 is a top cross-sectional view of another surgical toolembodiment of the present invention;

FIG. 98 is a cross-sectional view of a portion of a surgical endeffector embodiment of a surgical tool embodiment of the presentinvention;

FIG. 99 is a cross-sectional end view of the surgical end effector ofFIG. 103 taken along line 99-99 in FIG. 98;

FIG. 100 is a perspective view of the surgical end effector of FIGS. 98and 99 with portions thereof shown in cross-section;

FIG. 101 is a side view of a portion of the surgical end effector ofFIGS. 98-100;

FIG. 102 is a perspective view of a sled assembly embodiment of varioussurgical tool embodiments of the present invention;

FIG. 103 is a cross-sectional view of the sled assembly embodiment ofFIG. 102 and a portion of the elongated channel of FIG. 101;

FIGS. 104-109 diagrammatically depict the sequential firing of staplesin a surgical tool embodiment of the present invention;

FIG. 110 is a partial perspective view of a portion of a surgical endeffector embodiment of the present invention;

FIG. 111 is a partial cross-sectional perspective view of a portion of asurgical end effector embodiment of a surgical tool embodiment of thepresent invention;

FIG. 112 is another partial cross-sectional perspective view of thesurgical end effector embodiment of FIG. 111 with a sled assemblyaxially advancing therethrough;

FIG. 113 is a perspective view of another sled assembly embodiment ofanother surgical tool embodiment of the present invention;

FIG. 114 is a partial top view of a portion of the surgical end effectorembodiment depicted in FIGS. 111 and 112 with the sled assembly axiallyadvancing therethrough;

FIG. 115 is another partial top view of the surgical end effectorembodiment of FIG. 114 with the top surface of the surgical staplecartridge omitted for clarity;

FIG. 116 is a partial cross-sectional side view of a rotary driverembodiment and staple pusher embodiment of the surgical end effectordepicted in FIGS. 111 and 112;

FIG. 117 is a perspective view of an automated reloading systemembodiment of the present invention with a surgical end effector inextractive engagement with the extraction system thereof;

FIG. 118 is another perspective view of the automated reloading systemembodiment depicted in FIG. 117;

FIG. 119 is a cross-sectional elevational view of the automatedreloading system embodiment depicted in FIGS. 117 and 118;

FIG. 120 is another cross-sectional elevational view of the automatedreloading system embodiment depicted in FIGS. 117-119 with theextraction system thereof removing a spent surgical staple cartridgefrom the surgical end effector;

FIG. 121 is another cross-sectional elevational view of the automatedreloading system embodiment depicted in FIGS. 117-120 illustrating theloading of a new surgical staple cartridge into a surgical end effector;

FIG. 122 is a perspective view of another automated reloading systemembodiment of the present invention with some components shown incross-section;

FIG. 123 is an exploded perspective view of a portion of the automatedreloading system embodiment of FIG. 122;

FIG. 124 is another exploded perspective view of the portion of theautomated reloading system embodiment depicted in FIG. 123;

FIG. 125 is a cross-sectional elevational view of the automatedreloading system embodiment of FIGS. 122-124;

FIG. 126 is a cross-sectional view of an orientation tube embodimentsupporting a disposable loading unit therein;

FIG. 127 is a perspective view of another surgical tool embodiment ofthe present invention;

FIG. 128 is a partial perspective view of an articulation jointembodiment of a surgical tool embodiment of the present invention;

FIG. 129 is a perspective view of a closure tube embodiment of asurgical tool embodiment of the present invention;

FIG. 130 is a perspective view of the closure tube embodiment of FIG.129 assembled on the articulation joint embodiment of FIG. 128;

FIG. 131 is a top view of a portion of a tool mounting portionembodiment of a surgical tool embodiment of the present invention;

FIG. 132 is a perspective view of an articulation drive assemblyembodiment employed in the tool mounting portion embodiment of FIG. 131;

FIG. 133 is a perspective view of another surgical tool embodiment ofthe present invention; and

FIG. 134 is a perspective view of another surgical tool embodiment ofthe present invention.

DETAILED DESCRIPTION

Applicant of the present application also owns the following patentapplications that were filed on May 27, 2011 and which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 13/118,259, entitled SURGICAL        INSTRUMENT WITH WIRELESS COMMUNICATION BETWEEN A CONTROL UNIT OF        A ROBOTIC SYSTEM AND REMOTE SENSOR, now U.S. Pat. No. 8,684,253;    -   U.S. patent application Ser. No. 13/118,210, entitled        ROBOTICALLY-CONTROLLED DISPOSABLE MOTOR DRIVEN LOADING UNIT, now        U.S. Pat. No. 8,752,749;    -   U.S. patent application Ser. No. 13/118,253, entitled        ROBOTICALLY-CONTROLLED MOTORIZED SURGICAL INSTRUMENT, now U.S.        Patent Application Publication No. 2011/0295269;    -   U.S. patent application Ser. No. 13/118,278, entitled        ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE        FORMED STAPLES HAVING DIFFERENT LENGTHS, now U.S. Pat. No.        9,237,891;    -   U.S. patent application Ser. No. 13/118,190, entitled        ROBOTICALLY-CONTROLLED MOTORIZED CUTTING AND FASTENING        INSTRUMENT, now U.S. Pat. No. 9,179,912;    -   U.S. patent application Ser. No. 13/118,223, entitled        ROBOTICALLY-CONTROLLED SHAFT BASED ROTARY DRIVE SYSTEMS FOR        SURGICAL INSTRUMENTS, now U.S. Pat. No. 8,931,682;    -   U.S. patent application Ser. No. 13/118,263, entitled        ROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT HAVING RECORDING        CAPABILITIES, now U.S. Patent Application Publication No.        2011/0295295;    -   U.S. patent application Ser. No. 13/118,272, entitled        ROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT WITH FORCE FEEDBACK        CAPABILITIES, now U.S. Patent Application Publication No.        2011/0290856;    -   U.S. patent application Ser. No. 13/118,246, entitled        ROBOTICALLY-DRIVEN SURGICAL INSTRUMENT WITH E-BEAM DRIVER, now        U.S. Pat. No. 9,060,770; and    -   U.S. patent application Ser. No. 13/118,241, entitled SURGICAL        STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT        ARRANGEMENTS, now U.S. Pat. No. 9,072,535.

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the various embodiments of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

Uses of the phrases “in various embodiments,” “in some embodiments,” “inone embodiment”, or “in an embodiment”, or the like, throughout thespecification are not necessarily all referring to the same embodiment.Furthermore, the particular features, structures, or characteristics ofone or more embodiments may be combined in any suitable manner in one ormore other embodiments. Such modifications and variations are intendedto be included within the scope of the present invention.

The present invention provides method and devices for controlling aworking end of an endoscopic surgical device. In general, the endoscopicsurgical devices include an elongate shaft having a distal working endwith a flexible neck, and a proximal end with a handle for controllingmovement of the flexible neck on the distal working end. In certainexemplary embodiments, this can be achieved using, for example, one ormore cables that extend between the handle and the flexible neck suchthat movement of the handle applies a force to one or more of the cablesto cause the flexible portion to flex and thereby move the working endof the device. Various other features are also provided to facilitateuse of the device. A person skilled in the art will appreciate that theparticular device being controlled, and the particular configuration ofthe working end, can vary and that the various control techniquesdescribed herein can be used on virtually any surgical device in whichit is desirable to control movement of the working end.

FIGS. 1A and 1B illustrate one exemplary embodiment of a technique forcontrolling articulation of the end effector, and in particular forcausing the end effector to mimic and simultaneously move with thehandle. In this embodiment, the device is in the form of a linearstapling and cutting device 10 for applying multiple linear rows ofstaples to tissue and for cutting the stapled tissue. As shown, thedevice 10 generally includes an elongate shaft 12 having a proximal end12 a with a handle 14 coupled thereto, and a distal, working end 12 ahaving an end effector 16 coupled thereto or formed thereon, as will bediscussed in more detail below. In use, the end effector 16 isconfigured to mimic movement of the handle 14. Mimicking motion betweenthe handle 14 and the end effector 16 can generally be achieved using anactuator (not shown) that extends between the handle 14 and the endeffector 16, and that is effective to transfer forces from the handle 14to the end effector 16. In an exemplary embodiment, the actuator is inthe form of several cables that are spaced around a circumference of theelongate shaft 12, and that extend along the length of the elongateshaft 12. Movement of the handle 14 about the proximal end 12 a of theshaft 12 will apply a force to one or more of the cables to cause thecables to apply a force to the end effector 16, thereby causing the endeffector 16 to mimic the motion of the handle 14. Mimicking motion caninclude corresponding motion, whereby the end effector 16 moves in thesame direction and orientation as the handle 14, or mirrored motion,whereby the end effector 16 moves in an opposite direction andorientation as the handle 14. The mimicking motion can also beproportional to the movement of the handle.

The elongate shaft 12 of the device 10 can have a variety ofconfigurations. For example, it can be solid or hollow, and it can beformed from a single component or multiple segments. As shown in FIG. 2,the elongate shaft 12 is hollow and is formed from multiple connectingsegments to allow the elongate shaft 12 to flex. The flexibility of theshaft 12, as well as a relatively small diameter, allows the shaft 12 tobe used in endoscopic procedures, whereby the device is introducedtranslumenally through a natural orifice. The shaft can also vary inlength depending on the intended application.

FIG. 2 further illustrates one exemplary embodiment of an actuator 22 inthe form of several cables 34 a, 34 b, 34 c, 34 d that are spaced arounda circumference of the elongate shaft 12, and that extend along thelength of the elongate shaft 12. The number and location of the cablescan vary. For example, three cables can be spaced approximately 120°apart from one another around the circumference of the shaft 12. In theembodiment shown in FIG. 2, four cables 34 a, 34 b, 34 c, 34 d arespaced approximately 90° apart from one another around the circumferenceof the shaft 12. Each cable 34 a-d can extend through a pathway, such asa lumen, formed on, in, or around the elongate shaft 12. FIG. 2illustrates each cable 34 a-d extending through a cut-out formed on anexternal surface of each segment of the shaft 12. Thus, each segmentincludes four cut-outs spaced equidistant around the circumference ofthe shaft 12 to maintain the cables 34 a-d equidistant from one another.The cut-outs preferably have a size that is effective to retain thecables 34 a-d therein while allowing the cables 34 a-d to freely sliderelative to the shaft 12.

The distal end of the cables 34 a-d can be mated to the end effector 16to control movement of the end effector 16. While the end effector 16can have a variety of configurations, and various end effectors known inthe art can be used, FIG. 3A illustrates one exemplary embodiment of anend effector 16 which generally includes opposed first and second jaws18, 20 that are adapted to receive tissue therebetween. The first jaw 18is adapted to contain a staple cartridge having multiple staplesdisposed therein and configured to be driven into tissue, and the secondjaw 20 forms an anvil for deforming the staples. The particularconfiguration and the basic operation of the end effector 16 can vary,and various end effectors 16 known in the art can be used. By way ofnon-limiting example, U.S. Pat. No. 6,978,921 entitled “SurgicalStapling Instrument Incorporating an E-Beam Firing Mechanism,” which isincorporated herein in its entirety, discloses one embodiment of an endeffector that can be used with the present invention.

In order to allow movement of the end effector 16 relative to theelongate shaft 12, the end effector 16 can be movably coupled to thedistal end 12 b of the elongate shaft 12. For example, the end effector16 can be pivotally coupled to the distal end 12 b of the elongate shaft12 by a pivoting or rotating joint. Alternatively, the end effector 16can include a flexible neck 26 formed thereon, as shown, for allowingmovement of the end effector 16 relative to the elongate shaft 12. Theflexible neck 26 can be formed integrally with the distal end 12 b ofthe shaft 12 and/or the proximal end of the jaws 18, 20, or it can be aseparate member that extends between the shaft 12 and the jaws 18, 20.As shown in FIG. 3A, the flexible neck 26 includes a first coupler 28for mating the flexible neck 26 to the proximal end of the opposed jaws18, 20, and a second coupler 30 for mating the flexible neck 26 to thedistal end of the elongate shaft 12. The couplers 28, 30 can beremovably of fixedly mated to the flexible neck 26 and/or to the jaws18, 20 and the shaft 12. The couplers 28, 30 also function to housecertain components of the end effector 16. For example, the firstcoupler 28 can function to anchor the cables therein, as will bediscussed below, and it can also function to house a gear and driverassembly for actuating (e.g., closing and firing) the jaws 18, 20.

In order to facilitate flexion of the flexible neck 26, the neck 26 caninclude one or more slits 32 formed therein. The quantity, location, andsize of the slits 32 can vary to obtain a desired flexibility. In theembodiment shown in FIG. 3A, the flexible neck 26 includes multiple rowsof slits 32, each row extending radially around the flexible neck 26 andeach row being spaced axially along the length of the flexible neck 26.Each row of slits contains two slits extending around the circumferenceof the neck 26, and each row of slits 32 is axially offset from oneanother. As a result, the flexible neck 26 includes alternating slits32. A person skilled in the particular pattern of the slits 32 can vary,and that FIG. 3A merely illustrates one pattern for forming slits 32 toallow flexion of the flexible neck 26. Other exemplary slitconfigurations will be discussed in more detail below.

As indicated above, the cables 34 a-d can be coupled to the end effector16 to allow the end effector 16 to move in coordination with the handle14. The connecting location of the cables 34 a-d with the end effector16 can vary depending on the desired movement. In the illustratedembodiment, the distal end of the cables 34 a-d is connected to thedistal end of the flexible neck 26, and in particular they extend intoand connect to the first coupler 28. FIG. 3B illustrates across-sectional view of the first coupler 28 showing four bores 28 a, 28b, 28 c, 28 d for receiving the four cables 34 a, 34 b, 34 c, 34 d,respectively. Virtually any technique known in the art can be used toconnect the cables 34 a-d to the coupler 28 including, for example,mechanical mating techniques such as adhesives, an interference fit, aball-and-socket connection, threads, etc. In use, the connection of thecables 34 a-d at the distal end of the flexible neck 26 will allow thecables 34 a-d to apply a tension to the flexible neck 26 when an axialforce is applied to the cables 34 a-d by the handle 14. This tensionwill cause the neck 26 to flex in a direction dictated by the amount oftension applied to each cable 34 a-d, as will be discussed in moredetail below.

The handle 14 of the device 10 can be used to control movement of theend effector 16, and in particular to articulate the end effector 16 andthus angularly orient it relative to a longitudinal axis A of theelongate shaft 12. While the handle 14 can have a variety ofconfigurations, in one exemplary embodiment the handle 14 is movablycoupled to the proximal end 12 a of the elongate shaft 12 such thatmovement of the handle 14 can be mimicked by the end effector 16. Whilevarious techniques can be used to movably couple the handle 14 to theshaft 12, in the embodiment shown in FIGS. 4A-4C, a ball-and-socketconnection is formed between the handle 14 and the proximal end 12 a ofthe elongate shaft 12. As best shown in FIG. 4B, the proximal end 12 aof the elongate shaft 12 includes a socket 24 formed therein, and thehandle 14 includes a hemi-spherical ball 13 a formed on a distal endthereof and configured to be rotatably seated within the socket 24. Thesocket 24 can be integrally formed with the proximal end 12 a of theelongate shaft, or it can be formed by coupling a hollow housing 12 c,as shown, to the proximal end 12 a of the elongate shaft 12. Thehemi-spherical ball 13 a can also be formed integrally with the handle14, or it can be a separate member that is coupled to the handle 14. Inorder to movably mate the handle 14 to the shaft 12, the hemi-sphericalball 13 a on the handle 14 can be retained within the socket 24 usingthe cables 34 a-d, which attach to the handle 14 as will be discussedbelow. However, other mating techniques can be used to movably mate thehandle 14 to the shaft 12. For example, the ball 13 a can be sphericaland it can be captured within a spherical socket formed in the proximalend 12 a of the elongate shaft 12, or a mating element, such as a pin,can extend through the ball 13 a to retain the ball 13 a within thesocket 24. While FIG. 4B illustrates a ball 13 a formed on the handle 14and a socket 24 formed in the shaft 12, the ball-and-socket connectioncan be reversed such that the ball is on the shaft 12 and the socket isin the handle 14. Moreover, a person skilled in the art will appreciatethat a variety of other techniques can be used to movably couple thehandle 14 to the proximal end 12 a of the elongate shaft 12.

In use, the handle 14 can articulate or pivotally move relative to theshaft 12 to cause the end effector 16 to mimic the movement of thehandle 14. This can be achieved by coupling the proximal end of thecables 34 a-d to the handle 14. The connecting location of the cables 34a-d with the handle 14 can vary depending on the desired movement. Inthe illustrated embodiment, the cables (only three cables 34 a, 34 b and34 c are shown in FIG. 4A) extend from the elongate shaft 12, throughthe hollow housing 12 c, and out of slots or openings formed in aproximal end of the hollow housing 12 c. The cables 34 a-d then extendaround the ball 13 a on the handle 14 and connect to a distal-facingsurface on the handle 14 that surrounds the ball 13 a. Virtually anytechnique known in the art can be used to connect the cables 34 a-d tothe handle 14 including, for example, mechanical mating techniques suchas adhesives, an interference fit, threads, etc. As shown in FIG. 4A,the handle 14 includes openings formed therein, and the proximal ends(not shown) of the cables 34 a-d can have a ball or other element formedthereon and configured to be captured within the openings. As furthershown in FIG. 4A, the cables (only three cables 34 a, 34 b and 34 c areshown) can remain spaced circumferentially around the handle 14. Thiswill allow movement of the handle 14 to be mirrored by the end effector16, as will be discussed in more detail below. Alternatively, the cables34 a-d can be crossed before they connect to the handle 14 to cause theend effector 16 to move in the same direction as the handle 14. Forexample, opposed cables 34 a and 34 c can cross one another and canconnect to opposed sides of the handle 14, and opposed cables 34 b and34 d can likewise cross one another and can connect to opposed sides ofthe handle 14. The cables 34 a-d can be crossed at any location, such aswithin the hollow housing 12 c on the proximal end 12 a of the shaft 12.

As further shown in FIGS. 4A and 4B, the handle 14 can also includeother features to facilitate use of the device. For example, the handle14 can include a translating member 38 that is effective to close thejaws 18, 20 on the end effector 16, and a rotating member 40 that iseffective to selectively rotate and actuate the end effector 16. Thetranslating and rotating members 38, 40 are described in more detail inU.S. patent application Ser. No. 11/277,320, entitled SURGICAL FASTENERAND CUTTER WITH SINGLE CABLE ACTUATOR by Mark Ortiz et al. and filed onMar. 23, 2006, now U.S. Pat. No. 7,575,144, which is hereby incorporatedby reference in its entirety. In other embodiments, the handle 14 caninclude triggers, knobs, etc. for rotating and/or actuating the endeffector 16.

Referring back to FIG. 1B, in use the handle 14 can be pivoted orangularly oriented relative to the proximal end 12 a of the elongateshaft 12 to effect mimicking movement of the end effector 16. Inparticular, pivoting the handle 14 about the elongate shaft 12 in afirst direction will apply a force to one or more of cables 34 a-d topull the cable(s) axially. As a result, the actuated cables will applytension to the flexible neck 26 to cause the neck 26 to flex. In orderto prevent the elongate shaft 12 from flexing in response to tensionapplied to the cables 34 a-d by the handle 14, the flexible neck 26 canhave a greater flexibility than the elongate shaft 12. This can beachieved, for example, using the alternating slits 32 as previouslydescribed, or in other embodiments the material can differ, or theelongate shaft can include a stabilizing element, such as a rodextending therethrough to render the shaft more rigid than the flexibleneck.

The direction of movement of the handle 14 will be mimicked by the endeffector 16, either in the same direction (i.e., corresponding movement)or in an opposite direction (i.e., mirrored movement), thus allowing auser to precisely control the position of the end effector 16. In anexemplary embodiment, the particular amount of movement of the endeffector 16 can be proportional to the amount of movement of the handle14. That is, the amount of movement of the end effector 16 can bedirectly equivalent to the amount of movement of the handle 14, or itcan be proportionally increased or decreased relative to the amount ofmovement of the handle 14. In certain embodiments, it may be desirableto have the amount of movement of the end effector 16 be increasedrelative to the amount of movement of the handle 14. As a result, onlysmall movements of the handle 14 will be necessary to allow largemovements of the end effector 16. While various techniques can beachieved to proportionally multiple or increase the movement of the endeffector 16, one exemplary embodiment of a force multiplying mechanismis an eccentric cam that is coupled to the cables and that increases themechanical advantage, either force or displacement, of the cables 34 a-das tension is applied to the cables 34 a-d by the handle 14.

A person skilled in the art will appreciate that, while the movementbetween the handle and the working end of the device can be proportionalin theory, in practice some lose of force will likely occur as the forceis transferred through the elongate shaft. Accordingly, proportionalmovement as used herein is intended to include applications in which thehandle and working end are configured to move in proportionate amounts,but in which some lose of force may occur during actual operation of thedevice.

The various devices disclosed herein can also include a variety of otherfeatures to facilitate use thereof. For example, the device 10 of FIG.1A can include an optical image gathering unit disposed on a distal endof the elongate shaft 12 and configured to acquire images duringendoscopic procedures. While the location of the unit can vary, in oneembodiment the optical image gathering unit can be disposed on thesecond coupler 30. In particular, FIG. 5 illustrates a ramp-shapedhousing 42 that protrudes from an outer surface of the coupler 30, andthat contains the optical image gathering unit therein. A viewing window44 is formed on a distal-facing surface of the housing 42 to allow theunit to acquire images of the end effector 16 and surrounding surgicalsite. The images from the optical image gathering unit can betransferred to an external image display screen, or alternatively thedevice 10 can include image display screen disposed on or coupled to aproximal portion of the device. FIG. 6 illustrates one embodiment of animage display screen 46 protruding outward from the handle 14.

As previously indicated, the various techniques disclosed herein forcontrolling movement of a working end of an endoscopic surgical devicecan be used in conjunction with a variety of medical devices. FIG. 7illustrates another embodiment of a medical device having an actuatorfor controlling movement of the working end thereof. In this embodiment,the medical device is in the form of an accessory channel 100 for usewith an endoscope. An accessory channel 100 is an external device thatcan mate to and slide along an endoscope to allow other tools, such asgrasper, cutters, etc., to be introduced therethrough and positioned inproximity to the viewing end of the endoscope. While the accessorychannel 100 can have virtually any configuration, shape, and size, inthe embodiment illustrated in FIG. 7 the accessory channel 100 includesan elongate tube or shaft 102 having an inner lumen extending betweenproximal and distal ends 102 a, 102 b thereof for receiving a tooltherethrough. The accessory channel 100 can also include a matingelement formed thereon for mating the accessory channel 100 directly toan endoscope or to a sleeve or other device disposed around anendoscope. While virtually any mating technique can be used, in theillustrated embodiment the mating element on the accessory channel 100is in the form of a rail 104 that extends along a length of the elongateshaft 102. The rail 104 is configured to be received in a complementarytrack formed on an endoscope or a device disposed around an endoscope,such as a sleeve. A person skilled in the art will appreciate that avariety of other techniques can be used to mate the accessory channeleither directly or indirectly to an endoscope.

In order to control movement of a working end of the accessory channel100, the device 100 can include features similar to those previouslydescribed. In particular, the device 100 can a flexible neck 108 formedon or coupled to the distal end 102 b of the elongate shaft 102, ahandle 106 formed on or coupled to the proximal end 102 a of theelongate shaft 102, and an actuator extending between the handle 106 andthe flexible neck 108. In this embodiment, the actuator is configured totransfer forces from the handle 106 to the flexible neck 108 such thatmovement of the handle 106 is mimicked by the flexible neck 108, thusallowing a tool extending through the accessory channel 100 to bepositioned at a desired angular orientation.

The flexible neck 108 can have a variety of configurations, and it canbe a separate member that is coupled to the elongate shaft 102, or itcan be formed integrally with the elongate shaft 102, as shown in FIG.7. The neck 108 can be made flexible using various techniques. Forexample, the neck 108 can be formed from one or more segments that moverelative to one another, and/or it can be formed from a flexiblematerial. In the exemplary embodiment shown in FIG. 8A, the neck 108includes several slits 112 formed therein and configured to providemaximum flexibility of the neck 108. While the size, quantity, andorientation of the slits 112 can vary to obtain the desired results, inthe illustrated embodiment the flexible neck 108 includes four columnsof slits (only three columns of slits, indicated by arrows 112 a, 112 b,112 c, are shown). Each column extends axially along a length of theflexible neck 108, and each column includes four row of slits spacedradially around circumference of the neck 108. Each column of slits 112is also axially offset from one another to allow the slits 112 tooverlap. In use, when tension is applied to the actuator, the slits 112will allow the neck 108 to bend or assume a curved configuration suchthat the neck 108 articulates relative to the remainder of the elongateshaft 102, as shown in FIGS. 8B and 8C.

In other embodiments, the slits can be positioned to allow flexion ofthe neck at multiple locations or bend points, or to otherwise allow theneck to flex into a predetermined position. By way of non-limitingexample, FIG. 9A illustrates another embodiment of a flexible neck 108′having two regions of slits 112′ formed therein. In particular, theflexible neck 108′ includes a distal region of slits 112 a′ and aproximal region of slits 112 b′. Each region 112 a′, 112 b′ can includeany number of slits positioned at any location to provide a desireddegree of flexibility in one or more desired directions. As shown inFIG. 9A, the proximal end distal regions of slits 112 a′, 112 b′ eachinclude two rows of slits formed on opposed sides of and extending alongthe length of the flexible neck 108′. In use, when tension is applied tothe flexible neck 108′, as will be discussed in more detail below, theneck 108′ will flex at both the proximal and distal regions 112 a′, 112b′ and thereby articulate relative to the remainder of the elongateshaft 102′. As shown in FIG. 9B, flexion can occur first in the distalregion 112 a′ of the neck 108′. Further tension applied to the neck 108′can then cause the proximal region 112 b′ to flex, as shown in FIG. 9C.In other embodiments, the slits positioning and/or size of the slits canbe configured to cause flexion to occur in the proximal region 112 b′before it occurs in the distal region 112 a′, or alternatively the slitscan be configured to cause simultaneous flexion of the proximal anddistal regions 112 b′, 112 a′. A person skilled in the art willappreciate that the quantity, position, size, and shape of the slits canbe adjusted to obtain the desired results. The particular configurationof the cut used to form each slit can also vary. For example, the widthand length of the slit can remain constant from an outer surface of theelongate shaft to an inner surface of the elongate shaft, oralternatively the width and length can increase or decrease such thatthe slit tapers or otherwise varies. By way of non-limiting example, atapering configuration can be formed by forming a slit having triangularconfiguration, where the length and width of the slit decrease from theouter surface to the inner surface of the elongate shaft.

As indicated above, the actuator is configured to apply tension to theflexible neck 108 to cause the neck 108 to articulate. The actuator canhave a variety of configurations, but in one exemplary embodiment theactuator is similar to the aforementioned actuator and includes one ormore cables that extend between the handle 106 and the distal end of theflexible neck 108 such that the handle 106 and the flexible neck 108 areoperatively associated. Each cable can be configured to apply tension tothe flexible neck 108 to cause the neck 108 to articulate in a plane ofmotion. Thus, where the device 100 includes only one cable, the flexibleneck 108 can articulate in a single plane of motion. Each additionalcable can allow the neck 108 to articulate in a different plane ofmotion. Where multiple cables are provided, the neck 108 can articulatein multiple planes of motion. Moreover, the cables can be simultaneouslytensioned, potentially allow for 360° articulation of the flexible neck108.

While the number of cables can vary, and the device 100 can include onlyone cable, in the embodiment shown in FIG. 7 the device 100 includesfour cables (only three cables 110 a, 110 b, 110 c are shown). A portionof the cables 110 a, 110 b, 110 c, 110 d is shown in more detail in FIG.10. As noted above, the cables 110 a-d extend along a length of theelongate shaft 102 between the handle 106 and the flexible neck 108. Theparticular location of the cables 110 a-d can vary, but in an exemplaryembodiment the cables 110 a-d are spaced radially around a circumferenceof the elongate shaft 102 and they extend between the distal-most end ofthe flexible neck 108 and the handle 106. The cables 110 a-d can extendinternally through or externally along the elongate shaft 102, or theycan extend through lumens or pathways formed in the sidewall of theelongate shaft 102. FIG. 11 illustrates a cross-sectional view of theelongate shaft 102, showing four lumens 103 a, 103 b, 103 c, 103 dformed therein. The lumens 103 a-d preferably have a size that allowsthe cables 116 a-d to slide therein, and they are spacedcircumferentially about the elongate shaft 102. The lumens 103 a-dextend between the proximal and distal ends 102 a, 102 b of the elongateshaft 102 to allow the cables 110 a-d to extend between the handle 106and the distal-most end of the flexible neck 108.

The distal end of the cables 110 a-d can mate to the distal most end ofthe flexible neck 108 using a variety of techniques, but in oneembodiment, shown in FIG. 12, the flexible neck 108 includes an end cap114 coupled to or formed on the distal-most end thereof. While theconfiguration of the end cap 114 can vary depending on the configurationof the actuator, in the illustrated embodiment the end cap 114 includesfour bores 114 a, 114 b, 114 c, 114 d formed therein and spaced around acircumference of the end cap 114 such that the bores 114 a-d align withthe lumens 103 a-d in the elongate shaft 102. Each bore 114 a-d isconfigured to receive one of the cables 110 a-d. Various matingtechniques can be used to retain the cables 110 a-d within the bores 114a-d. For example, FIG. 10 illustrates ball formed on the end of eachcable 110 a-d for retaining the ends of the cables 110 a-d in the bores114 a-d in the end cap 114. The end cap 114 can also include a centrallumen 116 formed therein for receiving a tool therethrough. The lumen116 can also function to facilitate positioning of a tool insertedthrough the accessory channel 100.

The proximal end of the cables 110 a-d can be mated to a handle 106 thatis coupled to a proximal end of the shaft 102. While the handle 106 canhave a variety of configurations, in one exemplary embodiment,previously shown in FIG. 7, the handle 106 can be in the form of ajoystick that is movably coupled to the proximal end 102 a of theelongate shaft 102, and in particular that is configured to articulaterelative to the proximal end 102 a of the elongate shaft 102. Thearticulating movement of the handle 106 can allow the motion of thehandle 106 to be mimicked by the flexible neck 108, as will be discussedbelow.

While articulating movement can be achieved using a variety of types ofjoints, in the illustrated embodiment a ball-and-socket connection isformed between the handle 106 and the elongate shaft 102. In particular,as shown in more detail in FIGS. 13A and 13B, the proximal end 102 a ofthe elongate shaft 102 includes a housing 103 formed thereon anddefining a socket 118 in a proximal end thereof. The handle 106 includesa ball 120 that is movably disposed within the socket 118, and thejoystick extends proximally from the ball 120 thus allowing the handle106 to articulate relative to the elongate shaft 102. A pin or othermechanism can be used to movably retain the ball 120 within the socket118. A person skilled in the art will appreciate that the handle canhave a variety of other shapes, and that various other techniques can beused to movably connect the handle 106 to the elongate shaft 102.

As indicated above, the proximal end of the cables 110 a-d is configuredto mate to the handle 106. Thus, the handle 106 can include features formating to the cables 110 a-d. While the particular mating features canvary depending on the configuration of the actuator, in an exemplaryembodiment the joystick 122 on the handle 106 includes four legs 124 a,124 b, 124 c, 124 d formed thereon. The legs 124 a-d are spaced around acircumference of the joystick 122, such that they are substantiallyaligned with the cables, and each leg 124 a-d is configured to mate to aterminal end of one of the cables 110 a-d. A ball-and-socket connection,as previously described with respect to the distal ends of the cables110 a-d, can be used to mate the cables 110 a-d to the legs, oralternatively any other mating technique known in the art can be used.

Referring back to FIG. 7, in use the handle 106 can be pivoted orangularly oriented relative to the proximal end 102 a of the elongateshaft 102 to effect mimicking movement of the flexible neck 108, and tothereby position a tool extending through the flexible neck 108. Asshown in FIGS. 7 and 13B, the joystick on the handle 106 can include alumen 107 formed therethrough and axially aligned with the lumen 102 cin the elongate shaft 102 for allowing a tool to be introduced throughthe device 100. In other embodiments, the handle 106 can be offset fromthe proximal end 102 a of the elongate shaft 102 such that the handle106 is coupled to the cables, but does not interfere with direct accessto the lumen 102 c in the elongate shaft 102.

In order to control movement of the flexible neck 108 and thus a toolpositioned therethrough, the handle 106 is pivoted or articulated aboutthe proximal end 102 a of the elongate shaft 102. For example, movementof the handle 106 in a first direction will cause the legs 124 a-d onthe handle 106 to apply a force to one or more of cables 110 a-d to pullthe cable(s) axially. As a result, the actuated cables will apply atension force to the flexible neck 108 to cause the neck 108 to flex. Inorder to prevent the elongate shaft 102 from flexing in response totension applied to the cables 110 a-d by the handle 106, the flexibleneck 108 can have a greater flexibility than the elongate shaft 102.This can be achieved, for example, using the slits as previouslydescribed, or in other embodiments the shaft 102 can include astabilizing element, such as a rod, extending therethrough to make theshaft 102 more rigid than the flexible neck 108. The direction ofmovement of the handle 106 will be mimicked by the flexible neck 108,either in the same direction (i.e., corresponding movement) or in anopposite direction (i.e., mirrored movement), thus allowing a user toprecisely control the position of the flexible neck 108, and thus tocontrol the position of a tool extending through the flexible neck 108.In an exemplary embodiment, the particular amount of movement of theflexible neck 108 can be proportional to the amount of movement of thehandle 106. That is, the amount of movement of the flexible neck 108 canbe directly equivalent to the amount of movement of the handle 106, orit can be proportionally increased or decreased relative to the amountof movement of the handle 106. In certain embodiments, it may bedesirable to have the amount of movement of the flexible neck 108 beincreased relative to the amount of movement of the handle 106. As aresult, only small movements of the handle 106 will be necessary toallow large movements of the flexible neck 108. While various techniquescan be achieved to proportionally multiple or increase the movement ofthe flexible neck 108, one exemplary embodiment of a force multiplyingmechanism is an eccentric cam that is coupled to the cables and thatincreases the mechanical advantage, either force or displacement, of thecables 110 a-d as tension is applied to the cables 110 a-d by the handle106.

As previously explained, while the movement between the handle and theworking end of the device can be proportional in theory, in practicesome lose of force will likely occur as the force is transferred throughthe elongate shaft. Accordingly, proportional movement as used herein isintended to include applications in which the handle and working end areconfigured to move in proportionate amounts, but in which some lose offorce may occur during actual operation of the device.

While FIGS. 1A and 7 illustrate devices in which the working end mimicsmovement of the handle, the handle can have a variety of otherconfigurations in which it is effective to articulate the working end ofthe device without having the working end of the device mimic movementof the handle. FIGS. 14A and 14B illustrate another embodiment of adevice 200 having a handle 204 that includes a rotatable member that iseffective to articulate a flexible neck 206 in one or more planes ofmotion relative to an elongate shaft 202 of the device. In general, theelongate shaft 202 of the device 200 is very similar to the elongateshaft 102 previously described, and it generally includes a flexibleneck 206 coupled to or formed on a distal end thereof. Four cableactuators (not shown) extend through the elongate shaft between thehandle 106 and the flexible neck 206. The shaft 102 and the cableactuators are similar to the shaft 102 and cable actuators 110 a-dpreviously described with respect to device 100, and thus they will notbe described in detail.

The handle 204 of the device 200 is shown in more detail in FIGS. 15Aand 15B. In general, the handle 204 includes one or more spoolsrotatably disposed therein. Each spool is configured to mate to andcontrol one of the cable actuators. Thus, rotation of each spool willwind up or release the cable, thereby causing the flexible neck 108 toflex and articulate in a particular direction. While the number ofspools can vary depending on the number of cable actuators, in theembodiment shown in FIGS. 15A and 15B, the handle 204 includes fourspools 208 a, 208 b, 210 a, 210 b. The first two spools 208 a, 208 b arecoupled to one another, and the second two spools 210 a, 210 b arecoupled to one another. A first cable 212 a is coupled to and woundaround the first spool 208 a, and a second cable 212 b is coupled to andwound around the second spool 208 b. The first and second cables 212 a,212 b are positioned on and extend along opposite sides of the elongateshaft 202. As a result, tension applied to the first cable 212 a willcause the flexible neck 206 to articulate in direction within a firstplane of motion, and tension applied to the second cable 212 b willcause the flexible neck 206 to articulate in the opposite directionwithin the same plane of motion. To allow tension to be applied to onlyone of the cables 212 a, 212 b, the first and second cables 212 a, 212 bare wound around the first and second spools 208 a, 208 b in oppositedirections. Thus, rotation of the first and second spools 208 a, 208 bwill wind and apply tension to one of the cables 212 a, 212 b whileunwinding and releasing tension on the other one of the cables 212 a,212 b. Third and fourth cables 212 c, 212 d are likewise wound aroundthe third and fourth spools 210 a, 210 b such that rotation of the thirdand fourth and second spools 210 a, 210 b will wind and apply tension toone of the cables 212 c, 212 d while unwinding and releasing tension onthe other one of the cables 212 c, 212 d. The third and fourth cables212 c, 212 d can extend along the shaft 102 at a position that isradially offset from the first and second cables 212 a, 212 b such thatthe third and fourth cables 212 c, 212 d cause articulation of theflexible neck 206 in a second, different plane of motion. For example,the third and fourth cables 212 c, 212 d can be offset from the firstand second cables 212 a, 212 b by about 90° such that the cables 212 a-dare all spaced substantially equidistant around the circumference of theelongate shaft 202. A person skilled in the art will appreciate that thehandle 204 can include any number of spools and cables to effectarticulation in a desired number of planes.

In order to control the spools 208 a, 208 b, 210 a, 210 b, the devicecan include one or more grasping members. As shown in FIGS. 15A and 15B,a first rotatable knob 214 is coupled to the first and second spools 208a, 208 b, and a second rotatable knob 216 is coupled to the third andfourth spools 210 a, 210 b. The knobs 214, 216 can be integrally formedwith the spools 208 a, 208 b, 210 a, 210 b, or they can be coupled tothe spools 208 a, 208 b, 210 a, 210 b by a shaft that extends throughthe spools 208 a, 208 b, 210 a, 210 b. In the illustrated embodiment,the first knob 214 is formed on or coupled directly to the first spool208 a, and the second knob 216 is coupled to the third and fourth spools210 a, 210 b by a shaft 218 that extends from the knob 216 through thefirst and second spools 208 a, 208 b, and that couples to the third andfourth spools 210 a, 210 b. In other words, the first and second spools208 a, 208 b are rotatably disposed around the shaft 218.

In certain exemplary embodiments, the spools and the rotatable knobs canalso differ in size. In the embodiment shown in FIGS. 15A and 15B, thefirst and second spools 208 a, 208 b, as well as the first rotatableknob 214, have a diameter that is greater than a diameter of the thirdand fourth spools 210 a, 210 b and the second rotatable knob 216. Whilenot necessary, such a configuration can be advantageous as it spaces thecables 212 a-d apart to prevent the cables 212 a-d from coming intocontact with one another.

In use, a tool can be positioned through the elongate shaft 202, and theknobs 214, 216 can be rotated to articulate the flexible neck 206 on theshaft 202 and thereby position the tool as desired. As shown in FIGS.14A and 14B, the handle 204 can include a lumen 205 extendingtherethrough and in alignment with the lumen in the elongate shaft 202for allowing a tool to be passed through the handle 204 and the shaft202. In other embodiments, the handle 204 can be offset from theelongate shaft 202 to provide direct access to the lumen in the elongateshaft 202. Once the tool is positioned through the shaft 202, the knobs214, 214 can be rotated to articulate the flexible neck 206 on thedistal end of the elongate shaft 202. In particular, the first knob 214can be rotated in a first direction, e.g., clockwise, to apply tensionto one of the cables, e.g., the first cable 212 a, while releasing orunwinding the other cable, e.g., the second cable 212 b. As a result,the tension applied to the first cable 212 a will pull the distal-mostend of the flexible neck 206 in a proximal direction, causing theflexible neck 206 to flex and thereby articulate in a first direction.Rotation of the first knob 214 in an opposite direction, e.g.,counterclockwise, will unwind the first cable 212 a while winding thesecond cable 212 b. The flexible neck 206 will return to its initial,linear configuration. Further rotation of the first knob 214 willcontinue to wind the second cable 212 b while unwinding the first cable212 a, thereby causing the flexible neck 206 to flex and articulate inan opposite direction along the same plane of motion. The second knob216 can be likewise rotated to articulate the flexible in a differentplane of motion. The knobs 214, 216 can also optionally be rotatedsimultaneously to articulate the flexible neck 206 in additional planesof motion different than the first and second planes of motion.

In other embodiments, the various devices disclosed herein can include alocking mechanism for locking the handle(s) and/or actuator in a fixedposition to maintain the working end of a device in desired articulatedor angular orientation. While the locking mechanism can have a varietyof configurations, in one exemplary embodiment the locking mechanism canbe in the form of a clamp that is effective to clamp down onto thecables and thereby prevent movement of the cables to lock the workingend in a desired orientation. The clamp can have a variety of shapes andsizes, and it can be positioned at various locations on the device.FIGS. 16A and 16B illustrate one exemplary embodiment of a clamp 300that is disposed around the hollow housing 12 c on the surgicalfastening and cutting device 10 of FIGS. 1A and 1B. The clamp 300 isgenerally ring-shaped and can be configured to be slidably or rotatablymated to the hollow housing 12 c adjacent to the openings through whichthe cables (only three cables 34 a, 34 b, 34 c are shown in FIG. 16B)extend. In an initial position, the clamp 300 is spaced apart from theopenings to allow free movement of the cables 34 a-d therethrough. Oncethe working end of the device, e.g., the end effector 16, is articulatedinto a desired position, the clamp 300 can moved axially along thehollow housing 12 c until it extends over the openings and engages thecables 34 a-d extending therefrom. The clamp 300 will thus preventmovement of the cables 34 a-d when the clamp 300 is in the lockedposition. In order to move the clamp 300 axially and to lock the clamp300 to the housing 12 c, the clamp 300 can include a mating elementformed thereon and configured to engage a corresponding mating elementformed on the housing 12 c. As shown in FIGS. 16A and 16B, the clampincludes threads 302 formed therein that are configured to mate withcorresponding threads (not shown) formed on the housing 12 c. As aresult, rotation of the clamp 300 about the housing 12 c will cause theclamp 300 to move between the initial and locked positions. A personskilled in the art will appreciate that various other mating techniquescan be used. Moreover, the locking mechanism can have a variety of otherconfigurations. For example, the handle can include a locking elementformed thereon and configured to lock the handle in a fixed, articulatedposition.

In other embodiments, the cables can be used to passively allowarticulation of the elongate shaft through a body lumen, and the clamp300 or other locking mechanism can be used to lock the working end ofthe device into position when desired. In such a configuration, thehandle can merely be used to facilitate grasping of the device.

In other embodiments, the cable actuators disclosed herein used toeffect articulation of a working end of a device can be formed from anelectroactive polymer material. Electroactive polymers (EAPs), alsoreferred to as artificial muscles, are materials that exhibitpiezoelectric, pyroelectric, or electrostrictive properties in responseto electrical or mechanical fields. In particular, EAPs are a set ofconductive doped polymers that change shape when an electrical voltageis applied. The conductive polymer can be paired to some form of ionicfluid or gel and electrodes, and the flow of ions from the fluid/gelinto or out of the conductive polymer can induce a shape change of thepolymer. Typically, a voltage potential in the range of about 1V to 4kVcan be applied depending on the particular polymer and ionic fluid orgel used. It is important to note that EAPs do not change volume whenenergized, rather they merely expand in one direction and contract in atransverse direction. Thus, the cable actuators previously disclosedherein can be replaced by EAP actuators, and the handle can beconfigured to activate an energy source to selectively deliver energy toone or more of the cables. In an exemplary embodiment, movement of thehandle can be configured to dictate the amount of the energy source, aswell as the cable(s) receiving the energy source. As a result, movementof the handle can still be mimicked by the working end of the device toprovide the user with the same, precise control over the position of theworking end. The energy source can be an internal source, such as abattery, or it can be an external source. In other embodiments, the EAPcable actuators can supplement the axial force applied to the cables bymovement of the handle and thereby proportionally increase the amount ofmovement of the working end relative to the handle.

In other aspects, the cable actuators can be formed from a shape-memorymaterial, such as Nitinol. Such a configuration allows tension to beapplied to the cables to articulate the end effector, yet allows thecables to return to an initial linear configuration without having tomanipulate the handle.

In yet another embodiment, the various devices disclosed herein,including portions thereof, can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, the device can be reconditioned for reuse after at least one use.Reconditioning can include any combination of the steps of disassemblyof the device, followed by cleaning or replacement of particular pieces,and subsequent reassembly. By way of example, the surgical stapling andfastening device shown in FIGS. 1A and 1B can be reconditioned after thedevice has been used in a medical procedure. The device can bedisassembled, and any number of the particular pieces can be selectivelyreplaced or removed in any combination. For example, for the surgicalstapling and cutting device, a cartridge disposed within the endeffector and containing a plurality of fasteners can be replaced byadding a new fastener cartridge to the end effector. Upon cleaningand/or replacement of particular parts, the device can be reassembledfor subsequent use either at a reconditioning facility, or by a surgicalteam immediately prior to a surgical procedure. Those skilled in the artwill appreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

Over the years a variety of minimally invasive robotic (or“telesurgical”) systems have been developed to increase surgicaldexterity as well as to permit a surgeon to operate on a patient in anintuitive manner. Many of such systems are disclosed in the followingU.S. patents which are each herein incorporated by reference in theirrespective entirety: U.S. Pat. No. 5,792,135, entitled ARTICULATEDSURGICAL INSTRUMENT FOR PERFORMING MINIMALLY INVASIVE SURGERY WITHENHANCED DEXTERITY AND SENSITIVITY, U.S. Pat. No. 6,231,565, entitledROBOTIC ARM DLUS FOR PERFORMING SURGICAL TASKS, U.S. Pat. No. 6,783,524,entitled ROBOTIC SURGICAL TOOL WITH ULTRASOUND CAUTERIZING AND CUTTINGINSTRUMENT, U.S. Pat. No. 6,364,888, entitled ALIGNMENT OF MASTER ANDSLAVE IN A MINIMALLY INVASIVE SURGICAL APPARATUS, U.S. Pat. No.7,524,320, entitled MECHANICAL ACTUATOR INTERFACE SYSTEM FOR ROBOTICSURGICAL TOOLS, U.S. Pat. No. 7,691,098, entitled PLATFORM LINK WRISTMECHANISM, U.S. Pat. No. 7,806,891, entitled REPOSITIONING ANDREORIENTATION OF MASTER/SLAVE RELATIONSHIP IN MINIMALLY INVASIVETELESURGERY, and U.S. Pat. No. 7,824,401, entitled SURGICAL TOOL WITHWRITED MONOPOLAR ELECTROSURGICAL END EFFECTORS. Many of such systems,however, have in the past been unable to generate the magnitude offorces required to effectively cut and fasten tissue.

FIG. 17 depicts one version of a master controller 1001 that may be usedin connection with a robotic arm slave cart 1100 of the type depicted inFIG. 18. Master controller 1001 and robotic arm slave cart 1100, as wellas their respective components and control systems are collectivelyreferred to herein as a robotic system 1000. Examples of such systemsand devices are disclosed in U.S. Pat. No. 7,524,320 which has beenherein incorporated by reference. Thus, various details of such deviceswill not be described in detail herein beyond that which may benecessary to understand various embodiments and forms of the presentinvention. As is known, the master controller 1001 generally includesmaster controllers (generally represented as 1003 in FIG. 17) which aregrasped by the surgeon and manipulated in space while the surgeon viewsthe procedure via a stereo display 1002. The master controllers 1001generally comprise manual input devices which preferably move withmultiple degrees of freedom, and which often further have an actuatablehandle for actuating tools (for example, for closing grasping saws,applying an electrical potential to an electrode, or the like).

As can be seen in FIG. 18, in one form, the robotic arm cart 1100 isconfigured to actuate a plurality of surgical tools, generallydesignated as 1200. Various robotic surgery systems and methodsemploying master controller and robotic arm cart arrangements aredisclosed in U.S. Pat. No. 6,132,368, entitled “Multi-ComponentTelepresence System and Method”, the full disclosure of which isincorporated herein by reference. In various forms, the robotic arm cart1100 includes a base 1002 from which, in the illustrated embodiment,three surgical tools 1200 are supported. In various forms, the surgicaltools 1200 are each supported by a series of manually articulatablelinkages, generally referred to as set-up joints 1104, and a roboticmanipulator 1106. These structures are herein illustrated withprotective covers extending over much of the robotic linkage. Theseprotective covers may be optional, and may be limited in size orentirely eliminated in some embodiments to minimize the inertia that isencountered by the servo mechanisms used to manipulate such devices, tolimit the volume of moving components so as to avoid collisions, and tolimit the overall weight of the cart 1100. Cart 1100 will generally havedimensions suitable for transporting the cart 1100 between operatingrooms. The cart 1100 may be configured to typically fit through standardoperating room doors and onto standard hospital elevators. In variousforms, the cart 1100 would preferably have a weight and include a wheel(or other transportation) system that allows the cart 1100 to bepositioned adjacent an operating table by a single attendant.

Referring now to FIG. 19, in at least one form, robotic manipulators1106 may include a linkage 1108 that constrains movement of the surgicaltool 1200. In various embodiments, linkage 1108 includes rigid linkscoupled together by rotational joints in a parallelogram arrangement sothat the surgical tool 1200 rotates around a point in space 1110, asmore fully described in issued U.S. Pat. No. 5,817,084, the fulldisclosure of which is herein incorporated by reference. Theparallelogram arrangement constrains rotation to pivoting about an axis1112 a, sometimes called the pitch axis. The links supporting theparallelogram linkage are pivotally mounted to set-up joints 1104 (FIG.18) so that the surgical tool 1200 further rotates about an axis 1112 b,sometimes called the yaw axis. The pitch and yaw axes 1112 a, 1112 bintersect at the remote center 1114, which is aligned along a shaft 1208of the surgical tool 1200. The surgical tool 1200 may have furtherdegrees of driven freedom as supported by manipulator 1106, includingsliding motion of the surgical tool 1200 along the longitudinal toolaxis “LT-LT”. As the surgical tool 1200 slides along the tool axis LT-LTrelative to manipulator 1106 (arrow 1112 c), remote center 1114 remainsfixed relative to base 1116 of manipulator 1106. Hence, the entiremanipulator is generally moved to re-position remote center 1114.Linkage 1108 of manipulator 1106 is driven by a series of motors 1120.These motors actively move linkage 1108 in response to commands from aprocessor of a control system. As will be discussed in further detailbelow, motors 1120 are also employed to manipulate the surgical tool1200.

An alternative set-up joint structure is illustrated in FIG. 20. In thisembodiment, a surgical tool 1200 is supported by an alternativemanipulator structure 1106′ between two tissue manipulation tools. Thoseof ordinary skill in the art will appreciate that various embodiments ofthe present invention may incorporate a wide variety of alternativerobotic structures, including those described in U.S. Pat. No.5,878,193, entitled AUTOMATED ENDOSCOPE SYSTEM FOR OPTIMAL POSITIONING,the full disclosure of which is incorporated herein by reference.Additionally, while the data communication between a robotic componentand the processor of the robotic surgical system is primarily describedherein with reference to communication between the surgical tool 1200and the master controller 1001, it should be understood that similarcommunication may take place between circuitry of a manipulator, aset-up joint, an endoscope or other image capture device, or the like,and the processor of the robotic surgical system for componentcompatibility verification, component-type identification, componentcalibration (such as off-set or the like) communication, confirmation ofcoupling of the component to the robotic surgical system, or the like.

An exemplary non-limiting surgical tool 1200 that is well-adapted foruse with a robotic system 1000 that has a tool drive assembly 1010 (FIG.22) that is operatively coupled to a master controller 1001 that isoperable by inputs from an operator (i.e., a surgeon) is depicted inFIG. 21. As can be seen in that Figure, the surgical tool 1200 includesa surgical end effector 2012 that comprises an endocutter. In at leastone form, the surgical tool 1200 generally includes an elongated shaftassembly 2008 that has a proximal closure tube 2040 and a distal closuretube 2042 that are coupled together by an articulation joint 2011. Thesurgical tool 1200 is operably coupled to the manipulator by a toolmounting portion, generally designated as 1300. The surgical tool 1200further includes an interface 1230 which mechanically and electricallycouples the tool mounting portion 1300 to the manipulator. One form ofinterface 1230 is illustrated in FIGS. 22-26. In various embodiments,the tool mounting portion 1300 includes a tool mounting plate 1302 thatoperably supports a plurality of (four are shown in FIG. 26) rotatablebody portions, driven discs or elements 1304, that each include a pairof pins 1306 that extend from a surface of the driven element 1304. Onepin 1306 is closer to an axis of rotation of each driven elements 1304than the other pin 1306 on the same driven element 1304, which helps toensure positive angular alignment of the driven element 1304. Interface1230 includes an adaptor portion 1240 that is configured to mountinglyengage the mounting plate 1302 as will be further discussed below. Theadaptor portion 1240 may include an array of electrical connecting pins1242 (FIG. 24) which may be coupled to a memory structure by a circuitboard within the tool mounting portion 1300. While interface 1230 isdescribed herein with reference to mechanical, electrical, and magneticcoupling elements, it should be understood that a wide variety oftelemetry modalities might be used, including infrared, inductivecoupling, or the like.

As can be seen in FIGS. 22-25, the adapter portion 1240 generallyincludes a tool side 1244 and a holder side 1246. In various forms, aplurality of rotatable bodies 1250 are mounted to a floating plate 1248which has a limited range of movement relative to the surroundingadaptor structure normal to the major surfaces of the adaptor 1240.Axial movement of the floating plate 1248 helps decouple the rotatablebodies 1250 from the tool mounting portion 1300 when the levers 1303along the sides of the tool mounting portion housing 1301 are actuated(See FIG. 21). Other mechanisms/arrangements may be employed forreleasably coupling the tool mounting portion 1300 to the adaptor 1240.In at least one form, rotatable bodies 1250 are resiliently mounted tofloating plate 1248 by resilient radial members which extend into acircumferential indentation about the rotatable bodies 1250. Therotatable bodies 1250 can move axially relative to plate 1248 bydeflection of these resilient structures. When disposed in a first axialposition (toward tool side 1244) the rotatable bodies 1250 are free torotate without angular limitation. However, as the rotatable bodies 1250move axially toward tool side 1244, tabs 1252 (extending radially fromthe rotatable bodies 1250) laterally engage detents on the floatingplates so as to limit angular rotation of the rotatable bodies 1250about their axes. This limited rotation can be used to help drivinglyengage the rotatable bodies 1250 with drive pins 1272 of a correspondingtool holder portion 1270 of the robotic system 1000, as the drive pins1272 will push the rotatable bodies 1250 into the limited rotationposition until the pins 1234 are aligned with (and slide into) openings1256′. Openings 1256 on the tool side 1244 and openings 1256′ on theholder side 1246 of rotatable bodies 1250 are configured to accuratelyalign the driven elements 1304 (FIG. 26) of the tool mounting portion1300 with the drive elements 1271 of the tool holder 1270. As describedabove regarding inner and outer pins 1306 of driven elements 1304, theopenings 1256, 1256′ are at differing distances from the axis ofrotation on their respective rotatable bodies 1250 so as to ensure thatthe alignment is not 180 degrees from its intended position.Additionally, each of the openings 1256 is slightly radially elongatedso as to fittingly receive the pins 1306 in the circumferentialorientation. This allows the pins 1306 to slide radially within theopenings 1256, 1256′ and accommodate some axial misalignment between thetool 1200 and tool holder 1270, while minimizing any angularmisalignment and backlash between the drive and driven elements.Openings 1256 on the tool side 1244 are offset by about 90 degrees fromthe openings 1256′ (shown in broken lines) on the holder side 1246, ascan be seen most clearly in FIG. 25.

Various embodiments may further include an array of electrical connectorpins 1242 located on holder side 1246 of adaptor 1240, and the tool side1244 of the adaptor 1240 may include slots 1258 (FIG. 25) for receivinga pin array (not shown) from the tool mounting portion 1300. In additionto transmitting electrical signals between the surgical tool 1200 andthe tool holder 1270, at least some of these electrical connections maybe coupled to an adaptor memory device 1260 (FIG. 24) by a circuit boardof the adaptor 1240.

A detachable latch arrangement 1239 may be employed to releasably affixthe adaptor 1240 to the tool holder 1270. As used herein, the term “tooldrive assembly” when used in the context of the robotic system 1000, atleast encompasses various embodiments of the adapter 1240 and toolholder 1270 and which has been generally designated as 1010 in FIG. 22.For example, as can be seen in FIG. 22, the tool holder 1270 may includea first latch pin arrangement 1274 that is sized to be received incorresponding clevis slots 1241 provided in the adaptor 1240. Inaddition, the tool holder 1270 may further have second latch pins 1276that are sized to be retained in corresponding latch clevises 1243 inthe adaptor 1240. See FIG. 24. In at least one form, a latch assembly1245 is movably supported on the adapter 1240 and is biasable between afirst latched position wherein the latch pins 1276 are retained withintheir respective latch clevis 1243 and an unlatched position wherein thesecond latch pins 1276 may be into or removed from the latch clevises1243. A spring or springs (not shown) are employed to bias the latchassembly into the latched position. A lip on the tool side 1244 ofadaptor 1240 may slidably receive laterally extending tabs of toolmounting housing 1301.

Turning next to FIGS. 26-33, in at least one embodiment, the surgicaltool 1200 includes a surgical end effector 2012 that comprises in thisexample, among other things, at least one component 2024 that isselectively movable between first and second positions relative to atleast one other component 2022 in response to various control motionsapplied thereto as will be discussed in further detail below. In variousembodiments, component 2022 comprises an elongated channel 2022configured to operably support a surgical staple cartridge 2034 thereinand component 2024 comprises a pivotally translatable clamping member,such as an anvil 2024. Various embodiments of the surgical end effector2012 are configured to maintain the anvil 2024 and elongated channel2022 at a spacing that assures effective stapling and severing of tissueclamped in the surgical end effector 2012. As can be seen in FIG. 37,the surgical end effector 2012 further includes a cutting instrument2032 and a sled 2033. The cutting instrument 2032 may be, for example, aknife. The surgical staple cartridge 2034 operably houses a plurality ofsurgical staples (not show) therein that are supported on movable stapledrivers (not shown). As the cutting instrument 2032 is driven distallythrough a centrally-disposed slot (not shown) in the surgical staplecartridge 2034, it forces the sled 2033 distally as well. As the sled2033 is driven distally, its “wedge-shaped” configuration contacts themovable staple drivers and drives them vertically toward the closedanvil 2024. The surgical staples are formed as they are driven into theforming surface located on the underside of the anvil 2024. The sled2033 may be part of the surgical staple cartridge 2034, such that whenthe cutting instrument 2032 is retracted following the cuttingoperation, the sled 2033 does not retract. The anvil 2024 may bepivotably opened and closed at a pivot point 2025 located at theproximal end of the elongated channel 2022. The anvil 2024 may alsoinclude a tab 2027 at its proximal end that interacts with a componentof the mechanical closure system (described further below) to facilitatethe opening of the anvil 2024. The elongated channel 2022 and the anvil2024 may be made of an electrically conductive material (such as metal)so that they may serve as part of an antenna that communicates withsensor(s) in the end effector, as described above. The surgical staplecartridge 2034 could be made of a nonconductive material (such asplastic) and the sensor may be connected to or disposed in the surgicalstaple cartridge 2034, as was also described above.

As can be seen in FIGS. 26-33, the surgical end effector 2012 isattached to the tool mounting portion 1300 by an elongated shaftassembly 2008 according to various embodiments. As shown in theillustrated embodiment, the shaft assembly 2008 includes an articulationjoint generally indicated as 2011 that enables the surgical end effector2012 to be selectively articulated about an articulation axis AA-AA thatis substantially transverse to a longitudinal tool axis LT-LT. See FIG.27. In other embodiments, the articulation joint is omitted. In variousembodiments, the shaft assembly 2008 may include a closure tube assembly2009 that comprises a proximal closure tube 2040 and a distal closuretube 2042 that are pivotably linked by a pivot links 2044 and operablysupported on a spine assembly generally depicted as 2049. In theillustrated embodiment, the spine assembly 2049 comprises a distal spineportion 2050 that is attached to the elongated channel 2022 and ispivotally coupled to the proximal spine portion 2052. The closure tubeassembly 2009 is configured to axially slide on the spine assembly 2049in response to actuation motions applied thereto. The distal closuretube 2042 includes an opening 2045 into which the tab 2027 on the anvil2024 is inserted in order to facilitate opening of the anvil 2024 as thedistal closure tube 2042 is moved axially in the proximal direction“PD”. The closure tubes 2040, 2042 may be made of electricallyconductive material (such as metal) so that they may serve as part ofthe antenna, as described above. Components of the main drive shaftassembly (e.g., the drive shafts 2048, 2050) may be made of anonconductive material (such as plastic).

In use, it may be desirable to rotate the surgical end effector 2012about the longitudinal tool axis LT-LT. In at least one embodiment, thetool mounting portion 1300 includes a rotational transmission assembly2069 that is configured to receive a corresponding rotary output motionfrom the tool drive assembly 1010 of the robotic system 1000 and convertthat rotary output motion to a rotary control motion for rotating theelongated shaft assembly 2008 (and surgical end effector 2012) about thelongitudinal tool axis LT-LT. In various embodiments, for example, theproximal end 2060 of the proximal closure tube 2040 is rotatablysupported on the tool mounting plate 1302 of the tool mounting portion1300 by a forward support cradle 1309 and a closure sled 2100 that isalso movably supported on the tool mounting plate 1302. In at least oneform, the rotational transmission assembly 2069 includes a tube gearsegment 2062 that is formed on (or attached to) the proximal end 2060 ofthe proximal closure tube 2040 for operable engagement by a rotationalgear assembly 2070 that is operably supported on the tool mounting plate1302. As can be seen in FIG. 29, the rotational gear assembly 2070, inat least one embodiment, comprises a rotation drive gear 2072 that iscoupled to a corresponding first one of the driven discs or elements1304 on the adapter side 1307 of the tool mounting plate 1302 when thetool mounting portion 1300 is coupled to the tool drive assembly 1010.See FIG. 26. The rotational gear assembly 2070 further comprises arotary driven gear 2074 that is rotatably supported on the tool mountingplate 1302 in meshing engagement with the tube gear segment 2062 and therotation drive gear 2072. Application of a first rotary output motionfrom the tool drive assembly 1010 of the robotic system 1000 to thecorresponding driven element 1304 will thereby cause rotation of therotation drive gear 2072. Rotation of the rotation drive gear 2072ultimately results in the rotation of the elongated shaft assembly 2008(and the surgical end effector 2012) about the longitudinal tool axisLT-LT (represented by arrow “R” in FIG. 29). It will be appreciated thatthe application of a rotary output motion from the tool drive assembly1010 in one direction will result in the rotation of the elongated shaftassembly 2008 and surgical end effector 2012 about the longitudinal toolaxis LT-LT in a first direction and an application of the rotary outputmotion in an opposite direction will result in the rotation of theelongated shaft assembly 2008 and surgical end effector 2012 in a seconddirection that is opposite to the first direction.

In at least one embodiment, the closure of the anvil 2024 relative tothe staple cartridge 2034 is accomplished by axially moving the closuretube assembly 2009 in the distal direction “DD” on the spine assembly2049. As indicated above, in various embodiments, the proximal end 2060of the proximal closure tube 2040 is supported by the closure sled 2100which comprises a portion of a closure transmission, generally depictedas 2099. In at least one form, the closure sled 2100 is configured tosupport the closure tube 2009 on the tool mounting plate 1320 such thatthe proximal closure tube 2040 can rotate relative to the closure sled2100, yet travel axially with the closure sled 2100. In particular, ascan be seen in FIG. 34, the closure sled 2100 has an upstanding tab 2101that extends into a radial groove 2063 in the proximal end portion ofthe proximal closure tube 2040. In addition, as can be seen in FIGS. 31and 34, the closure sled 2100 has a tab portion 2102 that extendsthrough a slot 1305 in the tool mounting plate 1302. The tab portion2102 is configured to retain the closure sled 2100 in sliding engagementwith the tool mounting plate 1302. In various embodiments, the closuresled 2100 has an upstanding portion 2104 that has a closure rack gear2106 formed thereon. The closure rack gear 2106 is configured fordriving engagement with a closure gear assembly 2110. See FIG. 31.

In various forms, the closure gear assembly 2110 includes a closure spurgear 2112 that is coupled to a corresponding second one of the drivendiscs or elements 1304 on the adapter side 1307 of the tool mountingplate 1302. See FIG. 26. Thus, application of a second rotary outputmotion from the tool drive assembly 1010 of the robotic system 1000 tothe corresponding second driven element 1304 will cause rotation of theclosure spur gear 2112 when the tool mounting portion 1300 is coupled tothe tool drive assembly 1010. The closure gear assembly 2110 furtherincludes a closure reduction gear set 2114 that is supported in meshingengagement with the closure spur gear 2112. As can be seen in FIGS. 30and 31, the closure reduction gear set 2114 includes a driven gear 2116that is rotatably supported in meshing engagement with the closure spurgear 2112. The closure reduction gear set 2114 further includes a firstclosure drive gear 2118 that is in meshing engagement with a secondclosure drive gear 2120 that is rotatably supported on the tool mountingplate 1302 in meshing engagement with the closure rack gear 2106. Thus,application of a second rotary output motion from the tool driveassembly 1010 of the robotic system 1000 to the corresponding seconddriven element 1304 will cause rotation of the closure spur gear 2112and the closure transmission 2110 and ultimately drive the closure sled2100 and closure tube assembly 2009 axially. The axial direction inwhich the closure tube assembly 2009 moves ultimately depends upon thedirection in which the second driven element 1304 is rotated. Forexample, in response to one rotary output motion received from the tooldrive assembly 1010 of the robotic system 1000, the closure sled 2100will be driven in the distal direction “DD” and ultimately drive theclosure tube assembly 1009 in the distal direction. As the distalclosure tube 2042 is driven distally, the end of the closure tubesegment 2042 will engage a portion of the anvil 2024 and cause the anvil2024 to pivot to a closed position. Upon application of an “opening” output motion from the tool drive assembly 1010 of the robotic system 1000,the closure sled 2100 and shaft assembly 2008 will be driven in theproximal direction “PD”. As the distal closure tube 2042 is driven inthe proximal direction, the opening 2045 therein interacts with the tab2027 on the anvil 2024 to facilitate the opening thereof. In variousembodiments, a spring (not shown) may be employed to bias the anvil tothe open position when the distal closure tube 2042 has been moved toits starting position. In various embodiments, the various gears of theclosure gear assembly 2110 are sized to generate the necessary closureforces needed to satisfactorily close the anvil 2024 onto the tissue tobe cut and stapled by the surgical end effector 2012. For example, thegears of the closure transmission 2110 may be sized to generateapproximately 70-120 pounds.

In various embodiments, the cutting instrument 2032 is driven throughthe surgical end effector 2012 by a knife bar 2200. See FIGS. 32 and 34.In at least one form, the knife bar 2200 may be fabricated from, forexample, stainless steel or other similar material and has asubstantially rectangular cross-sectional shape. Such knife barconfiguration is sufficiently rigid to push the cutting instrument 2032through tissue clamped in the surgical end effector 2012, while stillbeing flexible enough to enable the surgical end effector 2012 toarticulate relative to the proximal closure tube 2040 and the proximalspine portion 2052 about the articulation axis AA-AA as will bediscussed in further detail below. As can be seen in FIGS. 35 and 36,the proximal spine portion 2052 has a rectangular-shaped passage 2054extending therethrough to provide support to the knife bar 2200 as it isaxially pushed therethrough. The proximal spine portion 2052 has aproximal end 2056 that is rotatably mounted to a spine mounting bracket2057 attached to the tool mounting plate 1032. See FIG. 34. Sucharrangement permits the proximal spine portion 2052 to rotate, but notmove axially, within the proximal closure tube 2040.

As shown in FIG. 32, the distal end 2202 of the knife bar 2200 isattached to the cutting instrument 2032. The proximal end 2204 of theknife bar 2200 is rotatably affixed to a knife rack gear 2206 such thatthe knife bar 2200 is free to rotate relative to the knife rack gear2206. See FIG. 34. As can be seen in FIGS. 28-33, the knife rack gear2206 is slidably supported within a rack housing 2210 that is attachedto the tool mounting plate 1302 such that the knife rack gear 2206 isretained in meshing engagement with a knife gear assembly 2220. Morespecifically and with reference to FIG. 31, in at least one embodiment,the knife gear assembly 2220 includes a knife spur gear 2222 that iscoupled to a corresponding third one of the driven discs or elements1304 on the adapter side 1307 of the tool mounting plate 1302. See FIG.26. Thus, application of another rotary output motion from the roboticsystem 1000 through the tool drive assembly 1010 to the correspondingthird driven element 1304 will cause rotation of the knife spur gear2222. The knife gear assembly 2220 further includes a knife gearreduction set 2224 that includes a first knife driven gear 2226 and asecond knife drive gear 2228. The knife gear reduction set 2224 isrotatably mounted to the tool mounting plate 1302 such that the firstknife driven gear 2226 is in meshing engagement with the knife spur gear2222. Likewise, the second knife drive gear 2228 is in meshingengagement with a third knife drive gear 2230 that is rotatablysupported on the tool mounting plate 1302 in meshing engagement with theknife rack gear 2206. In various embodiments, the gears of the knifegear assembly 2220 are sized to generate the forces needed to drive thecutting element 2032 through the tissue clamped in the surgical endeffector 2012 and actuate the staples therein. For example, the gears ofthe knife drive assembly 2230 may be sized to generate approximately 40to 100 pounds. It will be appreciated that the application of a rotaryoutput motion from the tool drive assembly 1010 in one direction willresult in the axial movement of the cutting instrument 2032 in a distaldirection and application of the rotary output motion in an oppositedirection will result in the axial travel of the cutting instrument 2032in a proximal direction.

In various embodiments, the surgical tool 1200 employs and articulationsystem 2007 that includes an articulation joint 2011 that enables thesurgical end effector 2012 to be articulated about an articulation axisAA-AA that is substantially transverse to the longitudinal tool axisLT-LT. In at least one embodiment, the surgical tool 1200 includes firstand second articulation bars 2250 a, 2250 b that are slidably supportedwithin corresponding passages 2053 provided through the proximal spineportion 2052. See FIGS. 39 and 41. In at least one form, the first andsecond articulation bars 2250 a, 2250 b are actuated by an articulationtransmission generally designated as 2249 that is operably supported onthe tool mounting plate 1032. Each of the articulation bars 2250 a, 2250b has a proximal end 2252 that has a guide rod protruding therefromwhich extend laterally through a corresponding slot in the proximal endportion of the proximal spine portion 2052 and into a correspondingarcuate slot in an articulation nut 2260 which comprises a portion ofthe articulation transmission. FIG. 35 illustrates articulation bar 2250a. It will be understood that articulation bar 2250 b is similarlyconstructed. As can be seen in FIG. 35, for example, the articulationbar 2250 a has a guide rod 2254 which extends laterally through acorresponding slot 2058 in the proximal end portion 2056 of the distalspine portion 2050 and into a corresponding arcuate slot 2262 in thearticulation nut 2260. In addition, the articulation bar 2250 a has adistal end 2251 a that is pivotally coupled to the distal spine portion2050 by, for example, a pin 2253 a and articulation bar 2250 b has adistal end 2251 b that is pivotally coupled to the distal spine portion2050 by, for example, a pin 2253 b. In particular, the articulation bar2250 a is laterally offset in a first lateral direction from thelongitudinal tool axis LT-LT and the articulation bar 2250 b islaterally offset in a second lateral direction from the longitudinaltool axis LT-LT. Thus, axial movement of the articulation bars 2250 aand 2250 b in opposing directions will result in the articulation of thedistal spine portion 2050 as well as the surgical end effector 2012attached thereto about the articulation axis AA-AA as will be discussedin further detail below.

Articulation of the surgical end effector 2012 is controlled by rotatingthe articulation nut 2260 about the longitudinal tool axis LT-LT. Thearticulation nut 2260 is rotatably journaled on the proximal end portion2056 of the distal spine portion 2050 and is rotatably driven thereon byan articulation gear assembly 2270. More specifically and with referenceto FIG. 29, in at least one embodiment, the articulation gear assembly2270 includes an articulation spur gear 2272 that is coupled to acorresponding fourth one of the driven discs or elements 1304 on theadapter side 1307 of the tool mounting plate 1302. See FIG. 26. Thus,application of another rotary input motion from the robotic system 1000through the tool drive assembly 1010 to the corresponding fourth drivenelement 1304 will cause rotation of the articulation spur gear 2272 whenthe interface 1230 is coupled to the tool holder 1270. An articulationdrive gear 2274 is rotatably supported on the tool mounting plate 1302in meshing engagement with the articulation spur gear 2272 and a gearportion 2264 of the articulation nut 2260 as shown. As can be seen inFIGS. 34 and 35, the articulation nut 2260 has a shoulder 2266 formedthereon that defines an annular groove 2267 for receiving retainingposts 2268 therein. Retaining posts 2268 are attached to the toolmounting plate 1302 and serve to prevent the articulation nut 2260 frommoving axially on the proximal spine portion 2052 while maintaining theability to be rotated relative thereto. Thus, rotation of thearticulation nut 2260 in a first direction, will result in the axialmovement of the articulation bar 2250 a in a distal direction “DD” andthe axial movement of the articulation bar 2250 b in a proximaldirection “PD” because of the interaction of the guide rods 2254 withthe spiral slots 2262 in the articulation gear 2260. Similarly, rotationof the articulation nut 2260 in a second direction that is opposite tothe first direction will result in the axial movement of thearticulation bar 2250 a in the proximal direction “PD” as well as causearticulation bar 2250 b to axially move in the distal direction “DD”.Thus, the surgical end effector 2012 may be selectively articulatedabout articulation axis “AA-AA” in a first direction “FD” bysimultaneously moving the articulation bar 2250 a in the distaldirection “DD” and the articulation bar 2250 b in the proximal direction“PD”. Likewise, the surgical end effector 2012 may be selectivelyarticulated about the articulation axis “AA-AA” in a second direction“SD” by simultaneously moving the articulation bar 2250 a in theproximal direction “PD” and the articulation bar 2250 b in the distaldirection “DD.” See FIG. 27.

The tool embodiment described above employs an interface arrangementthat is particularly well-suited for mounting the roboticallycontrollable medical tool onto at least one form of robotic armarrangement that generates at least four different rotary controlmotions. Those of ordinary skill in the art will appreciate that suchrotary output motions may be selectively controlled through theprogrammable control systems employed by the robotic system/controller.For example, the tool arrangement described above may be well-suited foruse with those robotic systems manufactured by Intuitive Surgical, Inc.of Sunnyvale, Calif., U.S.A., many of which may be described in detailin various patents incorporated herein by reference. The unique andnovel aspects of various embodiments of the present invention serve toutilize the rotary output motions supplied by the robotic system togenerate specific control motions having sufficient magnitudes thatenable end effectors to cut and staple tissue. Thus, the uniquearrangements and principles of various embodiments of the presentinvention may enable a variety of different forms of the tool systemsdisclosed and claimed herein to be effectively employed in connectionwith other types and forms of robotic systems that supply programmedrotary or other output motions. In addition, as will become furtherapparent as the present Detailed Description proceeds, various endeffector embodiments of the present invention that require other formsof actuation motions may also be effectively actuated utilizing one ormore of the control motions generated by the robotic system.

FIGS. 38-42 illustrate yet another surgical tool 2300 that may beeffectively employed in connection with the robotic system 1000 that hasa tool drive assembly that is operably coupled to a controller of therobotic system that is operable by inputs from an operator and which isconfigured to provide at least one rotary output motion to at least onerotatable body portion supported on the tool drive assembly. In variousforms, the surgical tool 2300 includes a surgical end effector 2312 thatincludes an elongated channel 2322 and a pivotally translatable clampingmember, such as an anvil 2324, which are maintained at a spacing thatassures effective stapling and severing of tissue clamped in thesurgical end effector 2312. As shown in the illustrated embodiment, thesurgical end effector 2312 may include, in addition to thepreviously-mentioned elongated channel 2322 and anvil 2324, a cuttinginstrument 2332 that has a sled portion 2333 formed thereon, a surgicalstaple cartridge 2334 that is seated in the elongated channel 2322, anda rotary end effector drive shaft 2336 that has a helical screw threadformed thereon. The cutting instrument 2332 may be, for example, aknife. As will be discussed in further detail below, rotation of the endeffector drive shaft 2336 will cause the cutting instrument 2332 andsled portion 2333 to axially travel through the surgical staplecartridge 2334 to move between a starting position and an endingposition. The direction of axial travel of the cutting instrument 2332depends upon the direction in which the end effector drive shaft 2336 isrotated. The anvil 2324 may be pivotably opened and closed at a pivotpoint 2325 connected to the proximate end of the elongated channel 2322.The anvil 2324 may also include a tab 2327 at its proximate end thatoperably interfaces with a component of the mechanical closure system(described further below) to open and close the anvil 2324. When the endeffector drive shaft 2336 is rotated, the cutting instrument 2332 andsled 2333 will travel longitudinally through the surgical staplecartridge 2334 from the starting position to the ending position,thereby cutting tissue clamped within the surgical end effector 2312.The movement of the sled 2333 through the surgical staple cartridge 2334causes the staples therein to be driven through the severed tissue andagainst the closed anvil 2324, which turns the staples to fasten thesevered tissue. In one form, the elongated channel 2322 and the anvil2324 may be made of an electrically conductive material (such as metal)so that they may serve as part of the antenna that communicates withsensor(s) in the end effector, as described above. The surgical staplecartridge 2334 could be made of a nonconductive material (such asplastic) and the sensor may be connected to or disposed in the surgicalstaple cartridge 2334, as described above.

It should be noted that although the embodiments of the surgical tool2300 described herein employ a surgical end effector 2312 that staplesthe severed tissue, in other embodiments different techniques forfastening or sealing the severed tissue may be used. For example, endeffectors that use RF energy or adhesives to fasten the severed tissuemay also be used. U.S. Pat. No. 5,709,680, entitled ELECTROSURGICALHEMOSTATIC DEVICE to Yates et al., and U.S. Pat. No. 5,688,270, entitledELECTROSURGICAL HEMOSTATIC DEVICE WITH RECESSED AND/OR OFFSET ELECTRODESto Yates et al., which are incorporated herein by reference, disclosescutting instruments that use RF energy to fasten the severed tissue.U.S. patent application Ser. No. 11/267,811 to Morgan et al., now U.S.Pat. No. 7,673,783, and U.S. patent application Ser. No. 11/267,383 toShelton et al., now U.S. Pat. No. 7,607,557, which are also incorporatedherein by reference, disclose cutting instruments that use adhesives tofasten the severed tissue. Accordingly, although the description hereinrefers to cutting/stapling operations and the like, it should berecognized that this is an exemplary embodiment and is not meant to belimiting. Other tissue-fastening techniques may also be used.

In the illustrated embodiment, the surgical end effector 2312 is coupledto an elongated shaft assembly 2308 that is coupled to a tool mountingportion 2460 and defines a longitudinal tool axis LT-LT. In thisembodiment, the elongated shaft assembly 2308 does not include anarticulation joint. Those of ordinary skill in the art will understandthat other embodiments may have an articulation joint therein. In atleast one embodiment, the elongated shaft assembly 2308 comprises ahollow outer tube 2340 that is rotatably supported on a tool mountingplate 2462 of a tool mounting portion 2460 as will be discussed infurther detail below. In various embodiments, the elongated shaftassembly 2308 further includes a distal spine shaft 2350. Distal spineshaft 2350 has a distal end portion 2354 that is coupled to, orotherwise integrally formed with, a distal stationary base portion 2360that is non-movably coupled to the channel 2322. See FIGS. 39-41.

As shown in FIG. 39, the distal spine shaft 2350 has a proximal endportion 2351 that is slidably received within a slot 2355 in a proximalspine shaft 2353 that is non-movably supported within the hollow outertube 2340 by at least one support collar 2357. As can be further seen inFIGS. 39 and 40, the surgical tool 2300 includes a closure tube 2370that is constrained to only move axially relative to the distalstationary base portion 2360. The closure tube 2370 has a proximal end2372 that has an internal thread 2374 formed therein that is in threadedengagement with a transmission arrangement, generally depicted as 2375that is operably supported on the tool mounting plate 2462. In variousforms, the transmission arrangement 2375 includes a rotary drive shaftassembly, generally designated as 2381. When rotated, the rotary driveshaft assembly 2381 will cause the closure tube 2370 to move axially aswill be describe in further detail below. In at least one form, therotary drive shaft assembly 2381 includes a closure drive nut 2382 of aclosure clutch assembly generally designated as 2380. More specifically,the closure drive nut 2382 has a proximal end portion 2384 that isrotatably supported relative to the outer tube 2340 and is in threadedengagement with the closure tube 2370. For assembly purposes, theproximal end portion 2384 may be threadably attached to a retention ring2386. Retention ring 2386, in cooperation with an end 2387 of theclosure drive nut 2382, defines an annular slot 2388 into which ashoulder 2392 of a locking collar 2390 extends. The locking collar 2390is non-movably attached (e.g., welded, glued, etc.) to the end of theouter tube 2340. Such arrangement serves to affix the closure drive nut2382 to the outer tube 2340 while enabling the closure drive nut 2382 torotate relative to the outer tube 2340. The closure drive nut 2382further has a distal end 2383 that has a threaded portion 2385 thatthreadably engages the internal thread 2374 of the closure tube 2370.Thus, rotation of the closure drive nut 2382 will cause the closure tube2370 to move axially as represented by arrow “D” in FIG. 40.

Closure of the anvil 2324 and actuation of the cutting instrument 2332are accomplished by control motions that are transmitted by a hollowdrive sleeve 2400. As can be seen in FIGS. 39 and 40, the hollow drivesleeve 2400 is rotatably and slidably received on the distal spine shaft2350. The drive sleeve 2400 has a proximal end portion 2401 that isrotatably mounted to the proximal spine shaft 2353 that protrudes fromthe tool mounting portion 2460 such that the drive sleeve 2400 mayrotate relative thereto. See FIG. 39. As can also be seen in FIGS.39-41, the drive sleeve 2400 is rotated about the longitudinal tool axis“LT-LT” by a drive shaft 2440. The drive shaft 2440 has a drive gear2444 that is attached to its distal end 2442 and is in meshingengagement with a driven gear 2450 that is attached to the drive sleeve2400.

The drive sleeve 2400 further has a distal end portion 2402 that iscoupled to a closure clutch 2410 portion of the closure clutch assembly2380 that has a proximal face 2412 and a distal face 2414. The proximalface 2412 has a series of proximal teeth 2416 formed thereon that areadapted for selective engagement with corresponding proximal teethcavities 2418 formed in the proximal end portion 2384 of the closuredrive nut 2382. Thus, when the proximal teeth 2416 are in meshingengagement with the proximal teeth cavities 2418 in the closure drivenut 2382, rotation of the drive sleeve 2400 will result in rotation ofthe closure drive nut 2382 and ultimately cause the closure tube 2370 tomove axially as will be discussed in further detail below.

As can be most particularly seen in FIGS. 39 and 40, the distal face2414 of the drive clutch portion 2410 has a series of distal teeth 2415formed thereon that are adapted for selective engagement withcorresponding distal teeth cavities 2426 formed in a face plate portion2424 of a knife drive shaft assembly 2420. In various embodiments, theknife drive shaft assembly 2420 comprises a hollow knife shaft segment2430 that is rotatably received on a corresponding portion of the distalspine shaft 2350 that is attached to or protrudes from the stationarybase 2360. When the distal teeth 2415 of the closure clutch portion 2410are in meshing engagement with the distal teeth cavities 2426 in theface plate portion 2424, rotation of the drive sleeve 2400 will resultin rotation of the drive shaft segment 2430 about the stationary shaft2350. As can be seen in FIGS. 44-46, a knife drive gear 2432 is attachedto the drive shaft segment 2430 and is meshing engagement with a driveknife gear 2434 that is attached to the end effector drive shaft 2336.Thus, rotation of the drive shaft segment 2430 will result in therotation of the end effector drive shaft 2336 to drive the cuttinginstrument 2332 and sled 2333 distally through the surgical staplecartridge 2334 to cut and staple tissue clamped within the surgical endeffector 2312. The sled 2333 may be made of, for example, plastic, andmay have a sloped distal surface. As the sled 2333 traverses theelongated channel 2322, the sloped forward surface of the sled 2333pushes up or “drive” the staples in the surgical staple cartridge 2334through the clamped tissue and against the anvil 2324. The anvil 2324turns or “forms” the staples, thereby stapling the severed tissue. Asused herein, the term “fire” refers to the initiation of actionsrequired to drive the cutting instrument and sled portion in a distaldirection through the surgical staple cartridge to cut the tissueclamped in the surgical end effector and drive the staples through thesevered tissue.

In use, it may be desirable to rotate the surgical end effector 2312about the longitudinal tool axis LT-LT. In at least one embodiment, thetransmission arrangement 2375 includes a rotational transmissionassembly 2465 that is configured to receive a corresponding rotaryoutput motion from the tool drive assembly 1010 of the robotic system1000 and convert that rotary output motion to a rotary control motionfor rotating the elongated shaft assembly 2308 (and surgical endeffector 2312) about the longitudinal tool axis LT-LT. As can be seen inFIG. 42, a proximal end 2341 of the outer tube 2340 is rotatablysupported within a cradle arrangement 2343 attached to the tool mountingplate 2462 of the tool mounting portion 2460. A rotation gear 2345 isformed on or attached to the proximal end 2341 of the outer tube 2340 ofthe elongated shaft assembly 2308 for meshing engagement with a rotationgear assembly 2470 operably supported on the tool mounting plate 2462.In at least one embodiment, a rotation drive gear 2472 is coupled to acorresponding first one of the driven discs or elements 1304 on theadapter side of the tool mounting plate 2462 when the tool mountingportion 2460 is coupled to the tool drive assembly 1010. See FIGS. 26and 42. The rotation drive assembly 2470 further comprises a rotarydriven gear 2474 that is rotatably supported on the tool mounting plate2462 in meshing engagement with the rotation gear 2345 and the rotationdrive gear 2472. Application of a first rotary output motion from therobotic system 1000 through the tool drive assembly 1010 to thecorresponding driven element 1304 will thereby cause rotation of therotation drive gear 2472 by virtue of being operably coupled thereto.Rotation of the rotation drive gear 2472 ultimately results in therotation of the elongated shaft assembly 2308 (and the end effector2312) about the longitudinal tool axis LT-LT (primary rotary motion).

Closure of the anvil 2324 relative to the staple cartridge 2034 isaccomplished by axially moving the closure tube 2370 in the distaldirection “DD”. Axial movement of the closure tube 2370 in the distaldirection “DD” is accomplished by applying a rotary control motion tothe closure drive nut 2382. To apply the rotary control motion to theclosure drive nut 2382, the closure clutch 2410 must first be broughtinto meshing engagement with the proximal end portion 2384 of theclosure drive nut 2382. In various embodiments, the transmissionarrangement 2375 further includes a shifter drive assembly 2480 that isoperably supported on the tool mounting plate 2462. More specificallyand with reference to FIG. 42, it can be seen that a proximal endportion 2359 of the proximal spine portion 2353 extends through therotation gear 2345 and is rotatably coupled to a shifter gear rack 2481that is slidably affixed to the tool mounting plate 2462 through slots2482. The shifter drive assembly 2480 further comprises a shifter drivegear 2483 that is coupled to a corresponding second one of the drivendiscs or elements 1304 on the adapter side of the tool mounting plate2462 when the tool mounting portion 2460 is coupled to the tool holder1270. See FIGS. 26 and 42. The shifter drive assembly 2480 furthercomprises a shifter driven gear 2478 that is rotatably supported on thetool mounting plate 2462 in meshing engagement with the shifter drivegear 2483 and the shifter rack gear 2482. Application of a second rotaryoutput motion from the robotic system 1000 through the tool driveassembly 1010 to the corresponding driven element 1304 will therebycause rotation of the shifter drive gear 2483 by virtue of beingoperably coupled thereto. Rotation of the shifter drive gear 2483ultimately results in the axial movement of the shifter gear rack 2482and the proximal spine portion 2353 as well as the drive sleeve 2400 andthe closure clutch 2410 attached thereto. The direction of axial travelof the closure clutch 2410 depends upon the direction in which theshifter drive gear 2483 is rotated by the robotic system 1000. Thus,rotation of the shifter drive gear 2483 in a first rotary direction willresult in the axial movement of the closure clutch 2410 in the proximaldirection “PD” to bring the proximal teeth 2416 into meshing engagementwith the proximal teeth cavities 2418 in the closure drive nut 2382.Conversely, rotation of the shifter drive gear 2483 in a second rotarydirection (opposite to the first rotary direction) will result in theaxial movement of the closure clutch 2410 in the distal direction “DD”to bring the distal teeth 2415 into meshing engagement withcorresponding distal teeth cavities 2426 formed in the face plateportion 2424 of the knife drive shaft assembly 2420.

Once the closure clutch 2410 has been brought into meshing engagementwith the closure drive nut 2382, the closure drive nut 2382 is rotatedby rotating the closure clutch 2410. Rotation of the closure clutch 2410is controlled by applying rotary output motions to a rotary drivetransmission portion 2490 of transmission arrangement 2375 that isoperably supported on the tool mounting plate 2462 as shown in FIG. 42.In at least one embodiment, the rotary drive transmission 2490 includesa rotary drive assembly 2490′ that includes a gear 2491 that is coupledto a corresponding third one of the driven discs or elements 1304 on theadapter side of the tool mounting plate 2462 when the tool mountingportion 2460 is coupled to the tool holder 1270. See FIGS. 26 and 42.The rotary drive transmission 2490 further comprises a first rotarydriven gear 2492 that is rotatably supported on the tool mounting plate2462 in meshing engagement with a second rotary driven gear 2493 and therotary drive gear 2491. The second rotary driven gear 2493 is coupled toa proximal end portion 2443 of the drive shaft 2440.

Rotation of the rotary drive gear 2491 in a first rotary direction willresult in the rotation of the drive shaft 2440 in a first direction.Conversely, rotation of the rotary drive gear 2491 in a second rotarydirection (opposite to the first rotary direction) will cause the driveshaft 2440 to rotate in a second direction. As indicated above, thedrive shaft 2440 has a drive gear 2444 that is attached to its distalend 2442 and is in meshing engagement with a driven gear 2450 that isattached to the drive sleeve 2400. Thus, rotation of the drive shaft2440 results in rotation of the drive sleeve 2400.

A method of operating the surgical tool 2300 will now be described. Oncethe tool mounting portion 2462 has been operably coupled to the toolholder 1270 of the robotic system 1000 and oriented into positionadjacent the target tissue to be cut and stapled, if the anvil 2334 isnot already in the open position (FIG. 39), the robotic system 1000 mayapply the first rotary output motion to the shifter drive gear 2483which results in the axial movement of the closure clutch 2410 intomeshing engagement with the closure drive nut 2382 (if it is not alreadyin meshing engagement therewith). See FIG. 40. Once the controller 1001of the robotic system 1000 has confirmed that the closure clutch 2410 ismeshing engagement with the closure drive nut 2382 (e.g., by means ofsensor(s)) in the surgical end effector 2312 that are in communicationwith the robotic control system), the robotic controller 1001 may thenapply a second rotary output motion to the rotary drive gear 2492 which,as was described above, ultimately results in the rotation of the rotarydrive nut 2382 in the first direction which results in the axial travelof the closure tube 2370 in the distal direction “DD”. As the closuretube 2370 moved in the distal direction, it contacts a portion of theanvil 2323 and causes the anvil 2324 to pivot to the closed position toclamp the target tissue between the anvil 2324 and the surgical staplecartridge 2334. Once the robotic controller 1001 determines that theanvil 2334 has been pivoted to the closed position by correspondingsensor(s) in the surgical end effector 2312 in communication therewith,the robotic system 1000 discontinues the application of the secondrotary output motion to the rotary drive gear 2491. The roboticcontroller 1001 may also provide the surgeon with an indication that theanvil 2334 has been fully closed. The surgeon may then initiate thefiring procedure. In alternative embodiments, the firing procedure maybe automatically initiated by the robotic controller 1001. The roboticcontroller 1001 then applies the primary rotary control motion 2483 tothe shifter drive gear 2483 which results in the axial movement of theclosure clutch 2410 into meshing engagement with the face plate portion2424 of the knife drive shaft assembly 2420. See FIG. 41. Once thecontroller 1001 of the robotic system 1000 has confirmed that theclosure clutch 2410 is meshing engagement with the face plate portion2424 (by means of sensor(s)) in the end effector 2312 that are incommunication with the robotic controller 1001), the robotic controller1001 may then apply the second rotary output motion to the rotary drivegear 2492 which, as was described above, ultimately results in the axialmovement of the cutting instrument 2332 and sled portion 2333 in thedistal direction “DD” through the surgical staple cartridge 2334. As thecutting instrument 2332 moves distally through the surgical staplecartridge 2334, the tissue clamped therein is severed. As the sledportion 2333 is driven distally, it causes the staples within thesurgical staple cartridge to be driven through the severed tissue intoforming contact with the anvil 2324. Once the robotic controller 1001has determined that the cutting instrument 2324 has reached the endposition within the surgical staple cartridge 2334 (by means ofsensor(s)) in the end effector 2312 that are in communication with therobotic controller 1001), the robotic controller 1001 discontinues theapplication of the second rotary output motion to the rotary drive gear2491. Thereafter, the robotic controller 1001 applies the secondaryrotary output motion to the rotary drive gear 2491 which ultimatelyresults in the axial travel of the cutting instrument 2332 and sledportion 2333 in the proximal direction “PD” to the starting position.Once the robotic controller 1001 has determined that the cuttinginstrument 2324 has reached the starting position by means of sensor(s)in the surgical end effector 2312 that are in communication with therobotic controller 1001, the robotic controller 1001 discontinues theapplication of the secondary rotary output motion to the rotary drivegear 2491. Thereafter, the robotic controller 1001 applies the primaryrotary output motion to the shifter drive gear 2483 to cause the closureclutch 2410 to move into engagement with the rotary drive nut 2382. Oncethe closure clutch 2410 has been moved into meshing engagement with therotary drive nut 2382, the robotic controller 1001 then applies thesecondary output motion to the rotary drive gear 2491 which ultimatelyresults in the rotation of the rotary drive nut 2382 in the seconddirection to cause the closure tube 2370 to move in the proximaldirection “PD”. As can be seen in FIGS. 39-41, the closure tube 2370 hasan opening 2345 therein that engages the tab 2327 on the anvil 2324 tocause the anvil 2324 to pivot to the open position. In alternativeembodiments, a spring may also be employed to pivot the anvil 2324 tothe open position when the closure tube 2370 has been returned to thestarting position (FIG. 39).

FIGS. 43-47 illustrate yet another surgical tool 2500 that may beeffectively employed in connection with the robotic system 1000. Invarious forms, the surgical tool 2500 includes a surgical end effector2512 that includes a “first portion” in the form of an elongated channel2522 and a “second movable portion” in the form of a pivotallytranslatable clamping member, such as an anvil 2524, which aremaintained at a spacing that assures effective stapling and severing oftissue clamped in the surgical end effector 2512. As shown in theillustrated embodiment, the surgical end effector 2512 may include, inaddition to the previously-mentioned elongated channel 2522 and anvil2524, a “third movable portion” in the form of a cutting instrument2532, a sled (not shown), and a surgical staple cartridge 2534 that isremovably seated in the elongated channel 2522. The cutting instrument2532 may be, for example, a knife. The anvil 2524 may be pivotablyopened and closed at a pivot point 2525 connected to the proximate endof the elongated channel 2522. The anvil 2524 may also include a tab2527 at its proximate end that is configured to operably interface witha component of the mechanical closure system (described further below)to open and close the anvil 2524. When actuated, the knife 2532 and sledtravel longitudinally along the elongated channel 2522, thereby cuttingtissue clamped within the surgical end effector 2512. The movement ofthe sled along the elongated channel 2522 causes the staples of thesurgical staple cartridge 2534 to be driven through the severed tissueand against the closed anvil 2524, which turns the staples to fasten thesevered tissue. In one form, the elongated channel 2522 and the anvil2524 may be made of an electrically conductive material (such as metal)so that they may serve as part of the antenna that communicates withsensor(s) in the surgical end effector, as described above. The surgicalstaple cartridge 2534 could be made of a nonconductive material (such asplastic) and the sensor may be connected to or disposed in the surgicalstaple cartridge 2534, as described above.

It should be noted that although the embodiments of the surgical tool2500 described herein employ a surgical end effector 2512 that staplesthe severed tissue, in other embodiments different techniques forfastening or sealing the severed tissue may be used. For example, endeffectors that use RF energy or adhesives to fasten the severed tissuemay also be used. U.S. Pat. No. 5,709,680, entitled ELECTROSURGICALHEMOSTATIC DEVICE to Yates et al., and U.S. Pat. No. 5,688,270, entitledELECTROSURGICAL HEMOSTATIC DEVICE WITH RECESSED AND/OR OFFSET ELECTRODESto Yates et al., which are incorporated herein by reference, disclosescutting instruments that use RF energy to fasten the severed tissue.U.S. patent application Ser. No. 11/267,811 to Morgan et al., now U.S.Pat. No. 7,673,783, and U.S. patent application Ser. No. 11/267,383 toShelton et al., now U.S. Pat. No. 7,607,557, which are also incorporatedherein by reference, disclose cutting instruments that use adhesives tofasten the severed tissue. Accordingly, although the description hereinrefers to cutting/stapling operations and the like, it should berecognized that this is an exemplary embodiment and is not meant to belimiting. Other tissue-fastening techniques may also be used.

In the illustrated embodiment, the elongated channel 2522 of thesurgical end effector 2512 is coupled to an elongated shaft assembly2508 that is coupled to a tool mounting portion 2600. In at least oneembodiment, the elongated shaft assembly 2508 comprises a hollow spinetube 2540 that is non-movably coupled to a tool mounting plate 2602 ofthe tool mounting portion 2600. As can be seen in FIGS. 44 and 45, theproximal end 2523 of the elongated channel 2522 comprises a hollowtubular structure configured to be attached to the distal end 2541 ofthe spine tube 2540. In one embodiment, for example, the proximal end2523 of the elongated channel 2522 is welded or glued to the distal endof the spine tube 2540.

As can be further seen in FIGS. 44 and 45, in at least one non-limitingembodiment, the surgical tool 2500 further includes an axially movableactuation member in the form of a closure tube 2550 that is constrainedto move axially relative to the elongated channel 2522 and the spinetube 1540. The closure tube 2550 has a proximal end 2552 that has aninternal thread 2554 formed therein that is in threaded engagement witha rotatably movable portion in the form of a closure drive nut 2560.More specifically, the closure drive nut 2560 has a proximal end portion2562 that is rotatably supported relative to the elongated channel 2522and the spine tube 2540. For assembly purposes, the proximal end portion2562 is threadably attached to a retention ring 2570. The retention ring2570 is received in a groove 2529 formed between a shoulder 2527 on theproximal end 2523 of the elongated channel 2522 and the distal end 2541of the spine tube 1540. Such arrangement serves to rotatably support theclosure drive nut 2560 within the elongated channel 2522. Rotation ofthe closure drive nut 2560 will cause the closure tube 2550 to moveaxially as represented by arrow “D” in FIG. 44.

Extending through the spine tube 2540 and the closure drive nut 2560 isa drive member which, in at least one embodiment, comprises a knife bar2580 that has a distal end portion 2582 that is rotatably coupled to thecutting instrument 2532 such that the knife bar 2580 may rotate relativeto the cutting instrument 2582. As can be seen in FIG. 44-46, theclosure drive nut 2560 has a slot 2564 therein through which the knifebar 2580 can slidably extend. Such arrangement permits the knife bar2580 to move axially relative to the closure drive nut 2560. However,rotation of the knife bar 2580 about the longitudinal tool axis LT-LTwill also result in the rotation of the closure drive nut 2560. Theaxial direction in which the closure tube 2550 moves ultimately dependsupon the direction in which the knife bar 2580 and the closure drive nut2560 are rotated. As the closure tube 2550 is driven distally, thedistal end thereof will contact the anvil 2524 and cause the anvil 2524to pivot to a closed position. Upon application of an opening rotaryoutput motion from the robotic system 1000, the closure tube 2550 willbe driven in the proximal direction “PD” and pivot the anvil 2524 to theopen position by virtue of the engagement of the tab 2527 with theopening 2555 in the closure tube 2550.

In use, it may be desirable to rotate the surgical end effector 2512about the longitudinal tool axis LT-LT. In at least one embodiment, thetool mounting portion 2600 is configured to receive a correspondingfirst rotary output motion from the robotic system 1000 and convert thatfirst rotary output motion to a rotary control motion for rotating theelongated shaft assembly 2508 about the longitudinal tool axis LT-LT. Ascan be seen in FIG. 42, a proximal end 2542 of the hollow spine tube2540 is rotatably supported within a cradle arrangement 2603 attached toa tool mounting plate 2602 of the tool mounting portion 2600. Variousembodiments of the surgical tool 2500 further include a transmissionarrangement, generally depicted as 2605, that is operably supported onthe tool mounting plate 2602. In various forms the transmissionarrangement 2605 include a rotation gear 2544 that is formed on orattached to the proximal end 2542 of the spine tube 2540 for meshingengagement with a rotation drive assembly 2610 that is operablysupported on the tool mounting plate 2602. In at least one embodiment, arotation drive gear 2612 is coupled to a corresponding first one of therotational bodies, driven discs or elements 1304 on the adapter side ofthe tool mounting plate 2602 when the tool mounting portion 2600 iscoupled to the tool holder 1270. See FIGS. 26 and 47. The rotation driveassembly 2610 further comprises a rotary driven gear 2614 that isrotatably supported on the tool mounting plate 2602 in meshingengagement with the rotation gear 2544 and the rotation drive gear 2612.Application of a first rotary output motion from the robotic system 1000through the tool drive assembly 1010 to the corresponding drivenrotational body 1304 will thereby cause rotation of the rotation drivegear 2612 by virtue of being operably coupled thereto. Rotation of therotation drive gear 2612 ultimately results in the rotation of theelongated shaft assembly 2508 (and the end effector 2512) about thelongitudinal tool axis LT-LT.

Closure of the anvil 2524 relative to the surgical staple cartridge 2534is accomplished by axially moving the closure tube 2550 in the distaldirection “DD”. Axial movement of the closure tube 2550 in the distaldirection “DD” is accomplished by applying a rotary control motion tothe closure drive nut 2382. In various embodiments, the closure drivenut 2560 is rotated by applying a rotary output motion to the knife bar2580. Rotation of the knife bar 2580 is controlled by applying rotaryoutput motions to a rotary closure system 2620 that is operablysupported on the tool mounting plate 2602 as shown in FIG. 47. In atleast one embodiment, the rotary closure system 2620 includes a closuredrive gear 2622 that is coupled to a corresponding second one of thedriven rotatable body portions discs or elements 1304 on the adapterside of the tool mounting plate 2462 when the tool mounting portion 2600is coupled to the tool holder 1270. See FIGS. 26 and 47. The closuredrive gear 2622, in at least one embodiment, is in meshing drivingengagement with a closure gear train, generally depicted as 2623. Theclosure gear drive rain 2623 comprises a first driven closure gear 2624that is rotatably supported on the tool mounting plate 2602. The firstclosure driven gear 2624 is attached to a second closure driven gear2626 by a drive shaft 2628. The second closure driven gear 2626 is inmeshing engagement with a third closure driven gear 2630 that isrotatably supported on the tool mounting plate 2602. Rotation of theclosure drive gear 2622 in a second rotary direction will result in therotation of the third closure driven gear 2630 in a second direction.Conversely, rotation of the closure drive gear 2483 in a secondaryrotary direction (opposite to the second rotary direction) will causethe third closure driven gear 2630 to rotate in a secondary direction.

As can be seen in FIG. 47, a drive shaft assembly 2640 is coupled to aproximal end of the knife bar 2580. In various embodiments, the driveshaft assembly 2640 includes a proximal portion 2642 that has a squarecross-sectional shape. The proximal portion 2642 is configured toslideably engage a correspondingly shaped aperture in the third drivengear 2630. Such arrangement results in the rotation of the drive shaftassembly 2640 (and knife bar 2580) when the third driven gear 2630 isrotated. The drive shaft assembly 2640 is axially advanced in the distaland proximal directions by a knife drive assembly 2650. One form of theknife drive assembly 2650 comprises a rotary drive gear 2652 that iscoupled to a corresponding third one of the driven rotatable bodyportions, discs or elements 1304 on the adapter side of the toolmounting plate 2462 when the tool mounting portion 2600 is coupled tothe tool holder 1270. See FIGS. 26 and 47. The rotary driven gear 2652is in meshing driving engagement with a gear train, generally depictedas 2653. In at least one form, the gear train 2653 further comprises afirst rotary driven gear assembly 2654 that is rotatably supported onthe tool mounting plate 2602. The first rotary driven gear assembly 2654is in meshing engagement with a third rotary driven gear assembly 2656that is rotatably supported on the tool mounting plate 2602 and which isin meshing engagement with a fourth rotary driven gear assembly 2658that is in meshing engagement with a threaded portion 2644 of the driveshaft assembly 2640. Rotation of the rotary drive gear 2652 in a thirdrotary direction will result in the axial advancement of the drive shaftassembly 2640 and knife bar 2580 in the distal direction “DD”.Conversely, rotation of the rotary drive gear 2652 in a tertiary rotarydirection (opposite to the third rotary direction) will cause the driveshaft assembly 2640 and the knife bar 2580 to move in the proximaldirection.

A method of operating the surgical tool 2500 will now be described. Oncethe tool mounting portion 2600 has been operably coupled to the toolholder 1270 of the robotic system 1000, the robotic system 1000 canorient the surgical end effector 2512 in position adjacent the targettissue to be cut and stapled. If the anvil 2524 is not already in theopen position (FIG. 44), the robotic system 1000 may apply the secondrotary output motion to the closure drive gear 2622 which results in therotation of the knife bar 2580 in a second direction. Rotation of theknife bar 2580 in the second direction results in the rotation of theclosure drive nut 2560 in a second direction. As the closure drive nut2560 rotates in the second direction, the closure tube 2550 moves in theproximal direction “PD”. As the closure tube 2550 moves in the proximaldirection “PD”, the tab 2527 on the anvil 2524 interfaces with theopening 2555 in the closure tube 2550 and causes the anvil 2524 to pivotto the open position. In addition or in alternative embodiments, aspring (not shown) may be employed to pivot the anvil 2354 to the openposition when the closure tube 2550 has been returned to the startingposition (FIG. 44). The opened surgical end effector 2512 may then bemanipulated by the robotic system 1000 to position the target tissuebetween the open anvil 2524 and the surgical staple cartridge 2534.Thereafter, the surgeon may initiate the closure process by activatingthe robotic control system 1000 to apply the second rotary output motionto the closure drive gear 2622 which, as was described above, ultimatelyresults in the rotation of the closure drive nut 2382 in the seconddirection which results in the axial travel of the closure tube 2250 inthe distal direction “DD”. As the closure tube 2550 moves in the distaldirection, it contacts a portion of the anvil 2524 and causes the anvil2524 to pivot to the closed position to clamp the target tissue betweenthe anvil 2524 and the staple cartridge 2534. Once the roboticcontroller 1001 determines that the anvil 2524 has been pivoted to theclosed position by corresponding sensor(s) in the end effector 2512 thatare in communication therewith, the robotic controller 1001 discontinuesthe application of the second rotary output motion to the closure drivegear 2622. The robotic controller 1001 may also provide the surgeon withan indication that the anvil 2524 has been fully closed. The surgeon maythen initiate the firing procedure. In alternative embodiments, thefiring procedure may be automatically initiated by the roboticcontroller 1001.

After the robotic controller 1001 has determined that the anvil 2524 isin the closed position, the robotic controller 1001 then applies thethird rotary output motion to the rotary drive gear 2652 which resultsin the axial movement of the drive shaft assembly 2640 and knife bar2580 in the distal direction “DD”. As the cutting instrument 2532 movesdistally through the surgical staple cartridge 2534, the tissue clampedtherein is severed. As the sled portion (not shown) is driven distally,it causes the staples within the surgical staple cartridge 2534 to bedriven through the severed tissue into forming contact with the anvil2524. Once the robotic controller 1001 has determined that the cuttinginstrument 2532 has reached the end position within the surgical staplecartridge 2534 by means of sensor(s) in the surgical end effector 2512that are in communication with the robotic controller 1001, the roboticcontroller 1001 discontinues the application of the second rotary outputmotion to the rotary drive gear 2652. Thereafter, the robotic controller1001 applies the secondary rotary control motion to the rotary drivegear 2652 which ultimately results in the axial travel of the cuttinginstrument 2532 and sled portion in the proximal direction “PD” to thestarting position. Once the robotic controller 1001 has determined thatthe cutting instrument 2524 has reached the starting position by meansof sensor(s) in the end effector 2512 that are in communication with therobotic controller 1001, the robotic controller 1001 discontinues theapplication of the secondary rotary output motion to the rotary drivegear 2652. Thereafter, the robotic controller 1001 may apply thesecondary rotary output motion to the closure drive gear 2622 whichresults in the rotation of the knife bar 2580 in a secondary direction.Rotation of the knife bar 2580 in the secondary direction results in therotation of the closure drive nut 2560 in a secondary direction. As theclosure drive nut 2560 rotates in the secondary direction, the closuretube 2550 moves in the proximal direction “PD” to the open position.

FIGS. 48-53B illustrate yet another surgical tool 2700 that may beeffectively employed in connection with the robotic system 1000. Invarious forms, the surgical tool 2700 includes a surgical end effector2712 that includes a “first portion” in the form of an elongated channel2722 and a “second movable portion” in on form comprising a pivotallytranslatable clamping member, such as an anvil 2724, which aremaintained at a spacing that assures effective stapling and severing oftissue clamped in the surgical end effector 2712. As shown in theillustrated embodiment, the surgical end effector 2712 may include, inaddition to the previously-mentioned channel 2722 and anvil 2724, a“third movable portion” in the form of a cutting instrument 2732, a sled(not shown), and a surgical staple cartridge 2734 that is removablyseated in the elongated channel 2722. The cutting instrument 2732 maybe, for example, a knife. The anvil 2724 may be pivotably opened andclosed at a pivot point 2725 connected to the proximal end of theelongated channel 2722. The anvil 2724 may also include a tab 2727 atits proximal end that interfaces with a component of the mechanicalclosure system (described further below) to open and close the anvil2724. When actuated, the knife 2732 and sled to travel longitudinallyalong the elongated channel 2722, thereby cutting tissue clamped withinthe surgical end effector 2712. The movement of the sled along theelongated channel 2722 causes the staples of the surgical staplecartridge 2734 to be driven through the severed tissue and against theclosed anvil 2724, which turns the staples to fasten the severed tissue.In one form, the elongated channel 2722 and the anvil 2724 may be madeof an electrically conductive material (such as metal) so that they mayserve as part of the antenna that communicates with sensor(s) in thesurgical end effector, as described above. The surgical staple cartridge2734 could be made of a nonconductive material (such as plastic) and thesensor may be connected to or disposed in the surgical staple cartridge2734, as described above.

It should be noted that although the embodiments of the surgical tool2500 described herein employ a surgical end effector 2712 that staplesthe severed tissue, in other embodiments different techniques forfastening or sealing the severed tissue may be used. For example, endeffectors that use RF energy or adhesives to fasten the severed tissuemay also be used. U.S. Pat. No. 5,709,680, entitled ELECTROSURGICALHEMOSTATIC DEVICE to Yates et al., and U.S. Pat. No. 5,688,270, entitledELECTROSURGICAL HEMOSTATIC DEVICE WITH RECESSED AND/OR OFFSET ELECTRODESto Yates et al., which are incorporated herein by reference, disclosecutting instruments that use RF energy to fasten the severed tissue.U.S. patent application Ser. No. 11/267,811 to Morgan et al., now U.S.Pat. No. 7,673,783, and U.S. patent application Ser. No. 11/267,383 toShelton et al., now U.S. Pat. No. 7,607,557, which are also incorporatedherein by reference, disclose cutting instruments that use adhesives tofasten the severed tissue. Accordingly, although the description hereinrefers to cutting/stapling operations and the like, it should berecognized that this is an exemplary embodiment and is not meant to belimiting. Other tissue-fastening techniques may also be used.

In the illustrated embodiment, the elongated channel 2722 of thesurgical end effector 2712 is coupled to an elongated shaft assembly2708 that is coupled to a tool mounting portion 2900. Although notshown, the elongated shaft assembly 2708 may include an articulationjoint to permit the surgical end effector 2712 to be selectivelyarticulated about an axis that is substantially transverse to the toolaxis LT-LT. In at least one embodiment, the elongated shaft assembly2708 comprises a hollow spine tube 2740 that is non-movably coupled to atool mounting plate 2902 of the tool mounting portion 2900. As can beseen in FIGS. 49 and 50, the proximal end 2723 of the elongated channel2722 comprises a hollow tubular structure that is attached to the spinetube 2740 by means of a mounting collar 2790. A cross-sectional view ofthe mounting collar 2790 is shown in FIG. 51. In various embodiments,the mounting collar 2790 has a proximal flanged end 2791 that isconfigured for attachment to the distal end of the spine tube 2740. Inat least one embodiment, for example, the proximal flanged end 2791 ofthe mounting collar 2790 is welded or glued to the distal end of thespine tube 2740. As can be further seen in FIGS. 54 and 55, the mountingcollar 2790 further has a mounting hub portion 2792 that is sized toreceive the proximal end 2723 of the elongated channel 2722 thereon. Theproximal end 2723 of the elongated channel 2722 is non-movably attachedto the mounting hub portion 2792 by, for example, welding, adhesive,etc.

As can be further seen in FIGS. 49 and 50, the surgical tool 2700further includes an axially movable actuation member in the form of aclosure tube 2750 that is constrained to move axially relative to theelongated channel 2722. The closure tube 2750 has a proximal end 2752that has an internal thread 2754 formed therein that is in threadedengagement with a rotatably movable portion in the form of a closuredrive nut 2760. More specifically, the closure drive nut 2760 has aproximal end portion 2762 that is rotatably supported relative to theelongated channel 2722 and the spine tube 2740. For assembly purposes,the proximal end portion 2762 is threadably attached to a retention ring2770. The retention ring 2770 is received in a groove 2729 formedbetween a shoulder 2727 on the proximal end 2723 of the channel 2722 andthe mounting hub 2729 of the mounting collar 2790. Such arrangementserves to rotatably support the closure drive nut 2760 within thechannel 2722. Rotation of the closure drive nut 2760 will cause theclosure tube 2750 to move axially as represented by arrow “D” in FIG.49.

Extending through the spine tube 2740, the mounting collar 2790, and theclosure drive nut 2760 is a drive member, which in at least oneembodiment, comprises a knife bar 2780 that has a distal end portion2782 that is coupled to the cutting instrument 2732. As can be seen inFIGS. 49 and 50, the mounting collar 2790 has a passage 2793therethrough for permitting the knife bar 2780 to slidably passtherethrough. Similarly, the closure drive nut 2760 has a slot 2764therein through which the knife bar 2780 can slidably extend. Sucharrangement permits the knife bar 2780 to move axially relative to theclosure drive nut 2760.

Actuation of the anvil 2724 is controlled by a rotary driven closureshaft 2800. As can be seen in FIGS. 49 and 50, a distal end portion 2802of the closure drive shaft 2800 extends through a passage 2794 in themounting collar 2790 and a closure gear 2804 is attached thereto. Theclosure gear 2804 is configured for driving engagement with the innersurface 2761 of the closure drive nut 2760. Thus, rotation of theclosure shaft 2800 will also result in the rotation of the closure drivenut 2760. The axial direction in which the closure tube 2750 movesultimately depends upon the direction in which the closure shaft 2800and the closure drive nut 2760 are rotated. For example, in response toone rotary closure motion received from the robotic system 1000, theclosure tube 2750 will be driven in the distal direction “DD”. As theclosure tube 2750 is driven distally, the opening 2745 will engage thetab 2727 on the anvil 2724 and cause the anvil 2724 to pivot to a closedposition. Upon application of an opening rotary motion from the roboticsystem 1000, the closure tube 2750 will be driven in the proximaldirection “PD” and pivot the anvil 2724 to the open position. In variousembodiments, a spring (not shown) may be employed to bias the anvil 2724to the open position (FIG. 49).

In use, it may be desirable to rotate the surgical end effector 2712about the longitudinal tool axis LT-LT. In at least one embodiment, thetool mounting portion 2900 is configured to receive a correspondingfirst rotary output motion from the robotic system 1000 for rotating theelongated shaft assembly 2708 about the tool axis LT-LT. As can be seenin FIG. 53, a proximal end 2742 of the hollow spine tube 2740 isrotatably supported within a cradle arrangement 2903 and a bearingassembly 2904 that are attached to a tool mounting plate 2902 of thetool mounting portion 2900. A rotation gear 2744 is formed on orattached to the proximal end 2742 of the spine tube 2740 for meshingengagement with a rotation drive assembly 2910 that is operablysupported on the tool mounting plate 2902. In at least one embodiment, arotation drive gear 2912 is coupled to a corresponding first one of thedriven discs or elements 1304 on the adapter side of the tool mountingplate 2602 when the tool mounting portion 2600 is coupled to the toolholder 1270. See FIGS. 26 and 53. The rotation drive assembly 2910further comprises a rotary driven gear 2914 that is rotatably supportedon the tool mounting plate 2902 in meshing engagement with the rotationgear 2744 and the rotation drive gear 2912. Application of a firstrotary control motion from the robotic system 1000 through the toolholder 1270 and the adapter 1240 to the corresponding driven element1304 will thereby cause rotation of the rotation drive gear 2912 byvirtue of being operably coupled thereto. Rotation of the rotation drivegear 2912 ultimately results in the rotation of the elongated shaftassembly 2708 (and the end effector 2712) about the longitudinal toolaxis LT-LT (primary rotary motion).

Closure of the anvil 2724 relative to the staple cartridge 2734 isaccomplished by axially moving the closure tube 2750 in the distaldirection “DD”. Axial movement of the closure tube 2750 in the distaldirection “DD” is accomplished by applying a rotary control motion tothe closure drive nut 2760. In various embodiments, the closure drivenut 2760 is rotated by applying a rotary output motion to the closuredrive shaft 2800. As can be seen in FIG. 53, a proximal end portion 2806of the closure drive shaft 2800 has a driven gear 2808 thereon that isin meshing engagement with a closure drive assembly 2920. In variousembodiments, the closure drive system 2920 includes a closure drive gear2922 that is coupled to a corresponding second one of the drivenrotational bodies or elements 1304 on the adapter side of the toolmounting plate 2462 when the tool mounting portion 2900 is coupled tothe tool holder 1270. See FIGS. 26 and 53. The closure drive gear 2922is supported in meshing engagement with a closure gear train, generallydepicted as 2923. In at least one form, the closure gear rain 2923comprises a first driven closure gear 2924 that is rotatably supportedon the tool mounting plate 2902. The first closure driven gear 2924 isattached to a second closure driven gear 2926 by a drive shaft 2928. Thesecond closure driven gear 2926 is in meshing engagement with aplanetary gear assembly 2930. In various embodiments, the planetary gearassembly 2930 includes a driven planetary closure gear 2932 that isrotatably supported within the bearing assembly 2904 that is mounted ontool mounting plate 2902. As can be seen in FIGS. 53 and 53B, theproximal end portion 2806 of the closure drive shaft 2800 is rotatablysupported within the proximal end portion 2742 of the spine tube 2740such that the driven gear 2808 is in meshing engagement with centralgear teeth 2934 formed on the planetary gear 2932. As can also be seenin FIG. 53A, two additional support gears 2936 are attached to orrotatably supported relative to the proximal end portion 2742 of thespine tube 2740 to provide bearing support thereto. Such arrangementwith the planetary gear assembly 2930 serves to accommodate rotation ofthe spine shaft 2740 by the rotation drive assembly 2910 whilepermitting the closure driven gear 2808 to remain in meshing engagementwith the closure drive system 2920. In addition, rotation of the closuredrive gear 2922 in a first direction will ultimately result in therotation of the closure drive shaft 2800 and closure drive nut 2760which will ultimately result in the closure of the anvil 2724 asdescribed above. Conversely, rotation of the closure drive gear 2922 ina second opposite direction will ultimately result in the rotation ofthe closure drive nut 2760 in an opposite direction which results in theopening of the anvil 2724.

As can be seen in FIG. 53, the proximal end 2784 of the knife bar 2780has a threaded shaft portion 2786 attached thereto which is in drivingengagement with a knife drive assembly 2940. In various embodiments, thethreaded shaft portion 2786 is rotatably supported by a bearing 2906attached to the tool mounting plate 2902. Such arrangement permits thethreaded shaft portion 2786 to rotate and move axially relative to thetool mounting plate 2902. The knife bar 2780 is axially advanced in thedistal and proximal directions by the knife drive assembly 2940. Oneform of the knife drive assembly 2940 comprises a rotary drive gear 2942that is coupled to a corresponding third one of the rotatable bodies,driven discs or elements 1304 on the adapter side of the tool mountingplate 2902 when the tool mounting portion 2900 is coupled to the toolholder 1270. See FIGS. 26 and 53. The rotary drive gear 2942 is inmeshing engagement with a knife gear train, generally depicted as 2943.In various embodiments, the knife gear train 2943 comprises a firstrotary driven gear assembly 2944 that is rotatably supported on the toolmounting plate 2902. The first rotary driven gear assembly 2944 is inmeshing engagement with a third rotary driven gear assembly 2946 that isrotatably supported on the tool mounting plate 2902 and which is inmeshing engagement with a fourth rotary driven gear assembly 2948 thatis in meshing engagement with the threaded portion 2786 of the knife bar2780. Rotation of the rotary drive gear 2942 in one direction willresult in the axial advancement of the knife bar 2780 in the distaldirection “DD”. Conversely, rotation of the rotary drive gear 2942 in anopposite direction will cause the knife bar 2780 to move in the proximaldirection. Tool 2700 may otherwise be used as described above.

FIGS. 54 and 55 illustrate a surgical tool embodiment 2700 that issubstantially identical to tool 2700 that was described in detail above.However tool 2700′ includes a pressure sensor 2950 that is configured toprovide feedback to the robotic controller 1001 concerning the amount ofclamping pressure experienced by the anvil 2724. In various embodiments,for example, the pressure sensor may comprise a spring biased contactswitch. For a continuous signal, it would use either a cantilever beamwith a strain gage on it or a dome button top with a strain gage on theinside. Another version may comprise an off switch that contacts only ata known desired load. Such arrangement would include a dome on the basedwherein the dome is one electrical pole and the base is the otherelectrical pole. Such arrangement permits the robotic controller 1001 toadjust the amount of clamping pressure being applied to the tissuewithin the surgical end effector 2712 by adjusting the amount of closingpressure applied to the anvil 2724. Those of ordinary skill in the artwill understand that such pressure sensor arrangement may be effectivelyemployed with several of the surgical tool embodiments described hereinas well as their equivalent structures.

FIG. 56 illustrates a portion of another surgical tool 3000 that may beeffectively used in connection with a robotic system 1000. The surgicaltool 3003 employs on-board motor(s) for powering various components of asurgical end effector cutting instrument. In at least one non-limitingembodiment for example, the surgical tool 3000 includes a surgical endeffector in the form of an endocutter (not shown) that has an anvil (notshown) and surgical staple cartridge arrangement (not shown) of thetypes and constructions described above. The surgical tool 3000 alsoincludes an elongated shaft (not shown) and anvil closure arrangement(not shown) of the types described above. Thus, this portion of theDetailed Description will not repeat the description of those componentsbeyond that which is necessary to appreciate the unique and novelattributes of the various embodiments of surgical tool 3000.

In the depicted embodiment, the end effector includes a cuttinginstrument 3002 that is coupled to a knife bar 3003. As can be seen inFIG. 56, the surgical tool 3000 includes a tool mounting portion 3010that includes a tool mounting plate 3012 that is configured tomountingly interface with the adaptor portion 1240′ which is coupled tothe robotic system 1000 in the various manners described above. The toolmounting portion 3010 is configured to operably support a transmissionarrangement 3013 thereon. In at least one embodiment, the adaptorportion 1240′ may be identical to the adaptor portion 1240 described indetail above without the powered rotation bodies and disc membersemployed by adapter 1240. In other embodiments, the adaptor portion1240′ may be identical to adaptor portion 1240. Still othermodifications which are considered to be within the spirit and scope ofthe various forms of the present invention may employ one or more of themechanical motions (i.e., rotary motion(s)) from the tool holder portion1270 (as described hereinabove) to power/actuate the transmissionarrangement 3013 while also employing one or more motors within the toolmounting portion 3010 to power one or more other components of thesurgical end effector. In addition, while the end effector of thedepicted embodiment comprises an endocutter, those of ordinary skill inthe art will understand that the unique and novel attributes of thedepicted embodiment may be effectively employed in connection with othertypes of surgical end effectors without departing from the spirit andscope of various forms of the present invention.

In various embodiments, the tool mounting plate 3012 is configured to atleast house a first firing motor 3011 for supplying firing andretraction motions to the knife bar 3003 which is coupled to orotherwise operably interfaces with the cutting instrument 3002. The toolmounting plate 3012 has an array of electrical connecting pins 3014which are configured to interface with the slots 1258 (FIG. 25) in theadapter 1240′. Such arrangement permits the controller 1001 of therobotic system 1000 to provide control signals to the electronic controlcircuit 3020 of the surgical tool 3000. While the interface is describedherein with reference to mechanical, electrical, and magnetic couplingelements, it should be understood that a wide variety of telemetrymodalities might be used, including infrared, inductive coupling, or thelike.

Control circuit 3020 is shown in schematic form in FIG. 56. In one formor embodiment, the control circuit 3020 includes a power supply in theform of a battery 3022 that is coupled to an on-off solenoid poweredswitch 3024. Control circuit 3020 further includes an on/off firingsolenoid 3026 that is coupled to a double pole switch 3028 forcontrolling the rotational direction of the motor 3011. Thus, when thecontroller 1001 of the robotic system 1000 supplies an appropriatecontrol signal, switch 3024 will permit battery 3022 to supply power tothe double pole switch 3028. The controller 1001 of the robotic system1000 will also supply an appropriate signal to the double pole switch3028 to supply power to the motor 3011. When it is desired to fire thesurgical end effector (i.e., drive the cutting instrument 3002 distallythrough tissue clamped in the surgical end effector, the double poleswitch 3028 will be in a first position. When it is desired to retractthe cutting instrument 3002 to the starting position, the double poleswitch 3028 will be moved to the second position by the controller 1001.

Various embodiments of the surgical tool 3000 also employ a gear box3030 that is sized, in cooperation with a firing gear train 3031 that,in at least one non-limiting embodiment, comprises a firing drive gear3032 that is in meshing engagement with a firing driven gear 3034 forgenerating a desired amount of driving force necessary to drive thecutting instrument 3002 through tissue and to drive and form staples inthe various manners described herein. In the embodiment depicted in FIG.56, the driven gear 3034 is coupled to a screw shaft 3036 that is inthreaded engagement with a screw nut arrangement 3038 that isconstrained to move axially (represented by arrow “D”). The screw nutarrangement 3038 is attached to the firing bar 3003. Thus, by rotatingthe screw shaft 3036 in a first direction, the cutting instrument 3002is driven in the distal direction “DD” and rotating the screw shaft inan opposite second direction, the cutting instrument 3002 may beretracted in the proximal direction “PD”.

FIG. 57 illustrates a portion of another surgical tool 3000′ that issubstantially identical to tool 3000 described above, except that thedriven gear 3034 is attached to a drive shaft 3040. The drive shaft 3040is attached to a second driver gear 3042 that is in meshing engagementwith a third driven gear 3044 that is in meshing engagement with a screw3046 coupled to the firing bar 3003.

FIG. 58 illustrates another surgical tool 3200 that may be effectivelyused in connection with a robotic system 1000. In this embodiment, thesurgical tool 3200 includes a surgical end effector 3212 that in onenon-limiting form, comprises a component portion that is selectivelymovable between first and second positions relative to at least oneother end effector component portion. As will be discussed in furtherdetail below, the surgical tool 3200 employs on-board motors forpowering various components of a transmission arrangement 3305. Thesurgical end effector 3212 includes an elongated channel 3222 thatoperably supports a surgical staple cartridge 3234. The elongatedchannel 3222 has a proximal end 3223 that slidably extends into a hollowelongated shaft assembly 3208 that is coupled to a tool mounting portion3300. In addition, the surgical end effector 3212 includes an anvil 3224that is pivotally coupled to the elongated channel 3222 by a pair oftrunnions 3225 that are received within corresponding openings 3229 inthe elongated channel 3222. A distal end portion 3209 of the shaftassembly 3208 includes an opening 3245 into which a tab 3227 on theanvil 3224 is inserted in order to open the anvil 3224 as the elongatedchannel 3222 is moved axially in the proximal direction “PD” relative tothe distal end portion 3209 of the shaft assembly 3208. In variousembodiments, a spring (not shown) may be employed to bias the anvil 3224to the open position.

As indicated above, the surgical tool 3200 includes a tool mountingportion 3300 that includes a tool mounting plate 3302 that is configuredto operably support the transmission arrangement 3305 and to mountinglyinterface with the adaptor portion 1240′ which is coupled to the roboticsystem 1000 in the various manners described above. In at least oneembodiment, the adaptor portion 1240′ may be identical to the adaptorportion 1240 described in detail above without the powered disc membersemployed by adapter 1240. In other embodiments, the adaptor portion1240′ may be identical to adaptor portion 1240. However, in suchembodiments, because the various components of the surgical end effector3212 are all powered by motor(s) in the tool mounting portion 3300, thesurgical tool 3200 will not employ or require any of the mechanical(i.e., non-electrical) actuation motions from the tool holder portion1270 to power the surgical end effector 3200 components. Still othermodifications which are considered to be within the spirit and scope ofthe various forms of the present invention may employ one or more of themechanical motions from the tool holder portion 1270 (as describedhereinabove) to power/actuate one or more of the surgical end effectorcomponents while also employing one or more motors within the toolmounting portion to power one or more other components of the surgicalend effector.

In various embodiments, the tool mounting plate 3302 is configured tosupport a first firing motor 3310 for supplying firing and retractionmotions to the transmission arrangement 3305 to drive a knife bar 3335that is coupled to a cutting instrument 3332 of the type describedabove. As can be seen in FIG. 58, the tool mounting plate 3212 has anarray of electrical connecting pins 3014 which are configured tointerface with the slots 1258 (FIG. 25) in the adapter 1240′. Sucharrangement permits the controller 1001 of the robotic system 1000 toprovide control signals to the electronic control circuits 3320, 3340 ofthe surgical tool 3200. While the interface is described herein withreference to mechanical, electrical, and magnetic coupling elements, itshould be understood that a wide variety of telemetry modalities mightbe used, including infrared, inductive coupling, or the like.

In one form or embodiment, the first control circuit 3320 includes afirst power supply in the form of a first battery 3322 that is coupledto a first on-off solenoid powered switch 3324. The first firing controlcircuit 3320 further includes a first on/off firing solenoid 3326 thatis coupled to a first double pole switch 3328 for controlling therotational direction of the first firing motor 3310. Thus, when therobotic controller 1001 supplies an appropriate control signal, thefirst switch 3324 will permit the first battery 3322 to supply power tothe first double pole switch 3328. The robotic controller 1001 will alsosupply an appropriate signal to the first double pole switch 3328 tosupply power to the first firing motor 3310. When it is desired to firethe surgical end effector (i.e., drive the cutting instrument 3232distally through tissue clamped in the surgical end effector 3212, thefirst switch 3328 will be positioned in a first position by the roboticcontroller 1001. When it is desired to retract the cutting instrument3232 to the starting position, the robotic controller 1001 will send theappropriate control signal to move the first switch 3328 to the secondposition.

Various embodiments of the surgical tool 3200 also employ a first gearbox 3330 that is sized, in cooperation with a firing drive gear 3332coupled thereto that operably interfaces with a firing gear train 3333.In at least one non-limiting embodiment, the firing gear train 333comprises a firing driven gear 3334 that is in meshing engagement withdrive gear 3332, for generating a desired amount of driving forcenecessary to drive the cutting instrument 3232 through tissue and todrive and form staples in the various manners described herein. In theembodiment depicted in FIG. 58, the driven gear 3334 is coupled to adrive shaft 3335 that has a second driven gear 3336 coupled thereto. Thesecond driven gear 3336 is supported in meshing engagement with a thirddriven gear 3337 that is in meshing engagement with a fourth driven gear3338. The fourth driven gear 3338 is in meshing engagement with athreaded proximal portion 3339 of the knife bar 3235 that is constrainedto move axially. Thus, by rotating the drive shaft 3335 in a firstdirection, the cutting instrument 3232 is driven in the distal direction“DD” and rotating the drive shaft 3335 in an opposite second direction,the cutting instrument 3232 may be retracted in the proximal direction“PD”.

As indicated above, the opening and closing of the anvil 3224 iscontrolled by axially moving the elongated channel 3222 relative to theelongated shaft assembly 3208. The axial movement of the elongatedchannel 3222 is controlled by a closure control system 3339. In variousembodiments, the closure control system 3339 includes a closure shaft3340 which has a hollow threaded end portion 3341 that threadablyengages a threaded closure rod 3342. The threaded end portion 3341 isrotatably supported in a spine shaft 3343 that operably interfaces withthe tool mounting portion 3300 and extends through a portion of theshaft assembly 3208 as shown. The closure system 3339 further comprisesa closure control circuit 3350 that includes a second power supply inthe form of a second battery 3352 that is coupled to a second on-offsolenoid powered switch 3354. Closure control circuit 3350 furtherincludes a second on/off firing solenoid 3356 that is coupled to asecond double pole switch 3358 for controlling the rotation of a secondclosure motor 3360. Thus, when the robotic controller 1001 supplies anappropriate control signal, the second switch 3354 will permit thesecond battery 3352 to supply power to the second double pole switch3354. The robotic controller 1001 will also supply an appropriate signalto the second double pole switch 3358 to supply power to the secondmotor 3360. When it is desired to close the anvil 3224, the secondswitch 3348 will be in a first position. When it is desired to open theanvil 3224, the second switch 3348 will be moved to a second position.

Various embodiments of tool mounting portion 3300 also employ a secondgear box 3362 that is coupled to a closure drive gear 3364. The closuredrive gear 3364 is in meshing engagement with a closure gear train 3363.In various non-limiting forms, the closure gear train 3363 includes aclosure driven gear 3365 that is attached to a closure drive shaft 3366.Also attached to the closure drive shaft 3366 is a closure drive gear3367 that is in meshing engagement with a closure shaft gear 3360attached to the closure shaft 3340. FIG. 63 depicts the end effector3212 in the open position. As indicated above, when the threaded closurerod 3342 is in the position depicted in FIG. 58, a spring (not shown)biases the anvil 3224 to the open position. When it is desired to closethe anvil 3224, the robotic controller 1001 will activate the secondmotor 3360 to rotate the closure shaft 3340 to draw the threaded closurerod 3342 and the channel 3222 in the proximal direction ‘D’. As theanvil 3224 contacts the distal end portion 3209 of the shaft 3208, theanvil 3224 is pivoted to the closed position.

A method of operating the surgical tool 3200 will now be described. Oncethe tool mounting portion 3302 has be operably coupled to the toolholder 1270 of the robotic system 1000, the robotic system 1000 canorient the end effector 3212 in position adjacent the target tissue tobe cut and stapled. If the anvil 3224 is not already in the openposition, the robotic controller 1001 may activate the second closuremotor 3360 to drive the channel 3222 in the distal direction to theposition depicted in FIG. 58. Once the robotic controller 1001determines that the surgical end effector 3212 is in the open positionby sensor(s) in the and effector and/or the tool mounting portion 3300,the robotic controller 1001 may provide the surgeon with a signal toinform the surgeon that the anvil 3224 may then be closed. Once thetarget tissue is positioned between the open anvil 3224 and the surgicalstaple cartridge 3234, the surgeon may then commence the closure processby activating the robotic controller 1001 to apply a closure controlsignal to the second closure motor 3360. The second closure motor 3360applies a rotary motion to the closure shaft 3340 to draw the channel3222 in the proximal direction “PD” until the anvil 3224 has beenpivoted to the closed position. Once the robotic controller 1001determines that the anvil 3224 has been moved to the closed position bysensor(s) in the surgical end effector 3212 and/or in the tool mountingportion 3300 that are in communication with the robotic control system,the motor 3360 may be deactivated. Thereafter, the firing process may becommenced either manually by the surgeon activating a trigger, button,etc. on the controller 1001 or the controller 1001 may automaticallycommence the firing process.

To commence the firing process, the robotic controller 1001 activatesthe firing motor 3310 to drive the firing bar 3235 and the cuttinginstrument 3232 in the distal direction “DD”. Once robotic controller1001 has determined that the cutting instrument 3232 has moved to theending position within the surgical staple cartridge 3234 by means ofsensors in the surgical end effector 3212 and/or the motor drive portion3300, the robotic controller 1001 may provide the surgeon with anindication signal. Thereafter the surgeon may manually activate thefirst motor 3310 to retract the cutting instrument 3232 to the startingposition or the robotic controller 1001 may automatically activate thefirst motor 3310 to retract the cutting element 3232.

The embodiment depicted in FIG. 58 does not include an articulationjoint. FIGS. 64 and 65 illustrate surgical tools 3200′ and 3200″ thathave end effectors 3212′, 3212″, respectively that may be employed withan elongated shaft embodiment that has an articulation joint of thevarious types disclosed herein. For example, as can be seen in FIG. 59,a threaded closure shaft 3342 is coupled to the proximal end 3223 of theelongated channel 3222 by a flexible cable or other flexible member3345. The location of an articulation joint (not shown) within theelongated shaft assembly 3208 will coincide with the flexible member3345 to enable the flexible member 3345 to accommodate sucharticulation. In addition, in the above-described embodiment, theflexible member 33345 is rotatably affixed to the proximal end portion3223 of the elongated channel 3222 to enable the flexible member 3345 torotate relative thereto to prevent the flexible member 3229 from“winding up” relative to the channel 3222. Although not shown, thecutting element may be driven in one of the above described manners by aknife bar that can also accommodate articulation of the elongated shaftassembly. FIG. 60 depicts a surgical end effector 3212″ that issubstantially identical to the surgical end effector 3212 describedabove, except that the threaded closure rod 3342 is attached to aclosure nut 3347 that is constrained to only move axially within theelongated shaft assembly 3208. The flexible member 3345 is attached tothe closure nut 3347. Such arrangement also prevents the threadedclosure rod 3342 from winding-up the flexible member 3345. A flexibleknife bar 3235′ may be employed to facilitate articulation of thesurgical end effector 3212″.

The surgical tools 3200, 3200′, and 3200″ described above may alsoemploy anyone of the cutting instrument embodiments described herein. Asdescribed above, the anvil of each of the end effectors of these toolsis closed by drawing the elongated channel into contact with the distalend of the elongated shaft assembly. Thus, once the target tissue hasbeen located between the staple cartridge 3234 and the anvil 3224, therobotic controller 1001 can start to draw the channel 3222 inward intothe shaft assembly 3208. In various embodiments, however, to prevent theend effector 3212, 3212′, 3212″ from moving the target tissue with theend effector during this closing process, the controller 1001 maysimultaneously move the tool holder and ultimately the tool such tocompensate for the movement of the elongated channel 3222 so that, ineffect, the target tissue is clamped between the anvil and the elongatedchannel without being otherwise moved.

FIGS. 61-63 depict another surgical tool embodiment 3201 that issubstantially identical to surgical tool 3200″ described above, exceptfor the differences discussed below. In this embodiment, the threadedclosure rod 3342′ has variable pitched grooves. More specifically, ascan be seen in FIG. 62, the closure rod 3342′ has a distal groovesection 3380 and a proximal groove section 3382. The distal and proximalgroove sections 3380, 3382 are configured for engagement with a lug 3390supported within the hollow threaded end portion 3341′. As can be seenin FIG. 62, the distal groove section 3380 has a finer pitch than thegroove section 3382. Thus, such variable pitch arrangement permits theelongated channel 3222 to be drawn into the shaft 3208 at a first speedor rate by virtue of the engagement between the lug 3390 and theproximal groove segment 3382. When the lug 3390 engages the distalgroove segment, the channel 3222 will be drawn into the shaft 3208 at asecond speed or rate. Because the proximal groove segment 3382 iscoarser than the distal groove segment 3380, the first speed will begreater than the second speed. Such arrangement serves to speed up theinitial closing of the end effector for tissue manipulation and thenafter the tissue has been properly positioned therein, generate theamount of closure forces to properly clamp the tissue for cutting andsealing. Thus, the anvil 3234 initially closes fast with a lower forceand then applies a higher closing force as the anvil closes more slowly.

The surgical end effector opening and closing motions are employed toenable the user to use the end effector to grasp and manipulate tissueprior to fully clamping it in the desired location for cutting andsealing. The user may, for example, open and close the surgical endeffector numerous times during this process to orient the end effectorin a proper position which enables the tissue to be held in a desiredlocation. Thus, in at least some embodiments, to produce the highloading for firing, the fine thread may require as many as 5-10 fullrotations to generate the necessary load. In some cases, for example,this action could take as long as 2-5 seconds. If it also took anequally long time to open and close the end effector each time duringthe positioning/tissue manipulation process, just positioning the endeffector may take an undesirably long time. If that happens, it ispossible that a user may abandon such use of the end effector for use ofa conventional grasper device. Use of graspers, etc. may undesirablyincrease the costs associated with completing the surgical procedure.

The above-described embodiments employ a battery or batteries to powerthe motors used to drive the end effector components. Activation of themotors is controlled by the robotic system 1000. In alternativeembodiments, the power supply may comprise alternating current “AC” thatis supplied to the motors by the robotic system 1000. That is, the ACpower would be supplied from the system powering the robotic system 1000through the tool holder and adapter. In still other embodiments, a powercord or tether may be attached to the tool mounting portion 3300 tosupply the requisite power from a separate source of alternating ordirect current.

In use, the controller 1001 may apply an initial rotary motion to theclosure shaft 3340 (FIG. 58) to draw the elongated channel 3222 axiallyinwardly into the elongated shaft assembly 3208 and move the anvil froma first position to an intermediate position at a first rate thatcorresponds with the point wherein the distal groove section 3380transitions to the proximal groove section 3382. Further application ofrotary motion to the closure shaft 3340 will cause the anvil to movefrom the intermediate position to the closed position relative to thesurgical staple cartridge. When in the closed position, the tissue to becut and stapled is properly clamped between the anvil and the surgicalstaple cartridge.

FIGS. 64-68 illustrate another surgical tool embodiment 3400 of thepresent invention. This embodiment includes an elongated shaft assembly3408 that extends from a tool mounting portion 3500. The elongated shaftassembly 3408 includes a rotatable proximal closure tube segment 3410that is rotatably journaled on a proximal spine member 3420 that isrigidly coupled to a tool mounting plate 3502 of the tool mountingportion 3500. The proximal spine member 3420 has a distal end 3422 thatis coupled to an elongated channel portion 3522 of a surgical endeffector 3412. For example, in at least one embodiment, the elongatedchannel portion 3522 has a distal end portion 3523 that “hookinglyengages” the distal end 3422 of the spine member 3420. The elongatedchannel 3522 is configured to support a surgical staple cartridge 3534therein. This embodiment may employ one of the various cuttinginstrument embodiments disclosed herein to sever tissue that is clampedin the surgical end effector 3412 and fire the staples in the staplecartridge 3534 into the severed tissue.

Surgical end effector 3412 has an anvil 3524 that is pivotally coupledto the elongated channel 3522 by a pair of trunnions 3525 that arereceived in corresponding openings 3529 in the elongated channel 3522.The anvil 3524 is moved between the open (FIG. 64) and closed positions(FIGS. 65-67) by a distal closure tube segment 3430. A distal endportion 3432 of the distal closure tube segment 3430 includes an opening3445 into which a tab 3527 on the anvil 3524 is inserted in order toopen and close the anvil 3524 as the distal closure tube segment 3430moves axially relative thereto. In various embodiments, the opening 3445is shaped such that as the closure tube segment 3430 is moved in theproximal direction, the closure tube segment 3430 causes the anvil 3524to pivot to an open position. In addition or in the alternative, aspring (not shown) may be employed to bias the anvil 3524 to the openposition.

As can be seen in FIGS. 64-67, the distal closure tube segment 3430includes a lug 3442 that extends from its distal end 3440 into threadedengagement with a variable pitch groove/thread 3414 formed in the distalend 3412 of the rotatable proximal closure tube segment 3410. Thevariable pitch groove/thread 3414 has a distal section 3416 and aproximal section 3418. The pitch of the distal groove/thread section3416 is finer than the pitch of the proximal groove/thread section 3418.As can also be seen in FIGS. 64-67, the distal closure tube segment 3430is constrained for axial movement relative to the spine member 3420 byan axial retainer pin 3450 that is received in an axial slot 3424 in thedistal end of the spine member 3420.

As indicated above, the anvil 2524 is open and closed by rotating theproximal closure tube segment 3410. The variable pitch threadarrangement permits the distal closure tube segment 3430 to be driven inthe distal direction “DD” at a first speed or rate by virtue of theengagement between the lug 3442 and the proximal groove/thread section3418. When the lug 3442 engages the distal groove/thread section 3416,the distal closure tube segment 3430 will be driven in the distaldirection at a second speed or rate. Because the proximal groove/threadsection 3418 is coarser than the distal groove/thread segment 3416, thefirst speed will be greater than the second speed.

In at least one embodiment, the tool mounting portion 3500 is configuredto receive a corresponding first rotary motion from the roboticcontroller 1001 and convert that first rotary motion to a primary rotarymotion for rotating the rotatable proximal closure tube segment 3410about a longitudinal tool axis LT-LT. As can be seen in FIG. 68, aproximal end 3460 of the proximal closure tube segment 3410 is rotatablysupported within a cradle arrangement 3504 attached to a tool mountingplate 3502 of the tool mounting portion 3500. A rotation gear 3462 isformed on or attached to the proximal end 3460 of the closure tubesegment 3410 for meshing engagement with a rotation drive assembly 3470that is operably supported on the tool mounting plate 3502. In at leastone embodiment, a rotation drive gear 3472 is coupled to a correspondingfirst one of the driven discs or elements 1304 on the adapter side ofthe tool mounting plate 3502 when the tool mounting portion 3500 iscoupled to the tool holder 1270. See FIGS. 26 and 68. The rotation driveassembly 3470 further comprises a rotary driven gear 3474 that isrotatably supported on the tool mounting plate 3502 in meshingengagement with the rotation gear 3462 and the rotation drive gear 3472.Application of a first rotary control motion from the robotic controller1001 through the tool holder 1270 and the adapter 1240 to thecorresponding driven element 1304 will thereby cause rotation of therotation drive gear 3472 by virtue of being operably coupled thereto.Rotation of the rotation drive gear 3472 ultimately results in therotation of the closure tube segment 3410 to open and close the anvil3524 as described above.

As indicated above, the surgical end effector 3412 employs a cuttinginstrument of the type and constructions described above. FIG. 68illustrates one form of knife drive assembly 3480 for axially advancinga knife bar 3492 that is attached to such cutting instrument. One formof the knife drive assembly 3480 comprises a rotary drive gear 3482 thatis coupled to a corresponding third one of the driven discs or elements1304 on the adapter side of the tool mounting plate 3502 when the tooldrive portion 3500 is coupled to the tool holder 1270. See FIGS. 26 and68. The knife drive assembly 3480 further comprises a first rotarydriven gear assembly 3484 that is rotatably supported on the toolmounting plate 5200. The first rotary driven gear assembly 3484 is inmeshing engagement with a third rotary driven gear assembly 3486 that isrotatably supported on the tool mounting plate 3502 and which is inmeshing engagement with a fourth rotary driven gear assembly 3488 thatis in meshing engagement with a threaded portion 3494 of drive shaftassembly 3490 that is coupled to the knife bar 3492. Rotation of therotary drive gear 3482 in a second rotary direction will result in theaxial advancement of the drive shaft assembly 3490 and knife bar 3492 inthe distal direction “DD”. Conversely, rotation of the rotary drive gear3482 in a secondary rotary direction (opposite to the second rotarydirection) will cause the drive shaft assembly 3490 and the knife bar3492 to move in the proximal direction.

FIGS. 69-78 illustrate another surgical tool 3600 embodiment of thepresent invention that may be employed in connection with a roboticsystem 1000. As can be seen in FIG. 69, the tool 3600 includes an endeffector in the form of a disposable loading unit 3612. Various forms ofdisposable loading units that may be employed in connection with tool3600 are disclosed, for example, in U.S. Patent Application PublicationNo. US 2009/0206131, entitled END EFFECTOR ARRANGEMENTS FOR A SURGICALCUTTING AND STAPLING INSTRUMENT, the disclosure of which is hereinincorporated by reference in its entirety.

In at least one form, the disposable loading unit 3612 includes an anvilassembly 3620 that is supported for pivotal travel relative to a carrier3630 that operably supports a staple cartridge 3640 therein. A mountingassembly 3650 is pivotally coupled to the cartridge carrier 3630 toenable the carrier 3630 to pivot about an articulation axis AA-AArelative to a longitudinal tool axis LT-LT. Referring to FIG. 74,mounting assembly 3650 includes upper and lower mounting portions 3652and 3654. Each mounting portion includes a threaded bore 3656 on eachside thereof dimensioned to receive threaded bolts (not shown) forsecuring the proximal end of carrier 3630 thereto. A pair of centrallylocated pivot members 3658 extends between upper and lower mountingportions via a pair of coupling members 3660 which engage a distal endof a housing portion 3662. Coupling members 3660 each include aninterlocking proximal portion 3664 configured to be received in grooves3666 formed in the proximal end of housing portion 3662 to retainmounting assembly 3650 and housing portion 3662 in a longitudinallyfixed position in relation thereto.

In various forms, housing portion 3662 of disposable loading unit 3614includes an upper housing half 3670 and a lower housing half 3672contained within an outer casing 3674. The proximal end of housing half3670 includes engagement nubs 3676 for releasably engaging an elongatedshaft 3700 and an insertion tip 3678. Nubs 3676 form a bayonet-typecoupling with the distal end of the elongated shaft 3700 which will bediscussed in further detail below. Housing halves 3670, 3672 define achannel 3674 for slidably receiving axial drive assembly 3680. A secondarticulation link 3690 is dimensioned to be slidably positioned within aslot 3679 formed between housing halves 3670, 3672. A pair of blow outplates 3691 are positioned adjacent the distal end of housing portion3662 adjacent the distal end of axial drive assembly 3680 to preventoutward bulging of drive assembly 3680 during articulation of carrier3630.

In various embodiments, the second articulation link 3690 includes atleast one elongated metallic plate. Preferably, two or more metallicplates are stacked to form link 3690. The proximal end of articulationlink 3690 includes a hook portion 3692 configured to engage firstarticulation link 3710 extending through the elongated shaft 3700. Thedistal end of the second articulation link 3690 includes a loop 3694dimensioned to engage a projection formed on mounting assembly 3650. Theprojection is laterally offset from pivot pin 3658 such that linearmovement of second articulation link 3690 causes mounting assembly 3650to pivot about pivot pins 3658 to articulate the carrier 3630.

In various forms, axial drive assembly 3680 includes an elongated drivebeam 3682 including a distal working head 3684 and a proximal engagementsection 3685. Drive beam 3682 may be constructed from a single sheet ofmaterial or, preferably, multiple stacked sheets. Engagement section3685 includes a pair of engagement fingers which are dimensioned andconfigured to mountingly engage a pair of corresponding retention slotsformed in drive member 3686. Drive member 3686 includes a proximalporthole 3687 configured to receive the distal end 3722 of control rod2720 (See FIG. 78) when the proximal end of disposable loading unit 3614is engaged with elongated shaft 3700 of surgical tool 3600.

Referring to FIGS. 69 and 76-78, to use the surgical tool 3600, adisposable loading unit 3612 is first secured to the distal end ofelongated shaft 3700. It will be appreciated that the surgical tool 3600may include an articulating or a non-articulating disposable loadingunit. To secure the disposable loading unit 3612 to the elongated shaft3700, the distal end 3722 of control rod 3720 is inserted into insertiontip 3678 of disposable loading unit 3612, and insertion tip 3678 is slidlongitudinally into the distal end of the elongated shaft 3700 in thedirection indicated by arrow “A” in FIG. 76 such that hook portion 3692of second articulation link 3690 slides within a channel 3702 in theelongated shaft 3700. Nubs 3676 will each be aligned in a respectivechannel (not shown) in elongated shaft 3700. When hook portion 3692engages the proximal wall 3704 of channel 3702, disposable loading unit3612 is rotated in the direction indicated by arrow “B” in FIGS. 75 and78 to move hook portion 3692 of second articulation link 3690 intoengagement with finger 3712 of first articulation link 3710. Nubs 3676also form a “bayonet-type” coupling within annular channel 3703 in theelongated shaft 3700. During rotation of loading unit 3612, nubs 3676engage cam surface 3732 (FIG. 76) of block plate 3730 to initially moveplate 3730 in the direction indicated by arrow “C” in FIG. 81 to lockengagement member 3734 in recess 3721 of control rod 3720 to preventlongitudinal movement of control rod 3720 during attachment ofdisposable loading unit 3612. During the final degree of rotation, nubs3676 disengage from cam surface 3732 to allow blocking plate 3730 tomove in the direction indicated by arrow “D” in FIGS. 75 and 78 frombehind engagement member 3734 to once again permit longitudinal movementof control rod 3720. While the above-described attachment methodreflects that the disposable loading unit 3612 is manipulated relativeto the elongated shaft 3700, the person of ordinary skill in the artwill appreciate that the disposable loading unit 3612 may be supportedin a stationary position and the robotic system 1000 may manipulate theelongated shaft portion 3700 relative to the disposable loading unit3612 to accomplish the above-described coupling procedure.

FIG. 79 illustrates another disposable loading unit 3612′ that isattachable in a bayonet-type arrangement with the elongated shaft 3700′that is substantially identical to shaft 3700 except for the differencesdiscussed below. As can be seen in FIG. 79, the elongated shaft 3700′has slots 3705 that extend for at least a portion thereof and which areconfigured to receive nubs 3676 therein. In various embodiments, thedisposable loading unit 3612′ includes arms 3677 extending therefromwhich, prior to the rotation of disposable loading unit 3612′, can bealigned, or at least substantially aligned, with nubs 3676 extendingfrom housing portion 3662. In at least one embodiment, arms 3677 andnubs 3676 can be inserted into slots 3705 in elongated shaft 3700′, forexample, when disposable loading unit 3612′ is inserted into elongatedshaft 3700′. When disposable loading unit 3612′ is rotated, arms 3677can be sufficiently confined within slots 3705 such that slots 3705 canhold them in position, whereas nubs 3676 can be positioned such thatthey are not confined within slots 3705 and can be rotated relative toarms 3677. When rotated, the hook portion 3692 of the articulation link3690 is engaged with the first articulation link 3710 extending throughthe elongated shaft 3700′.

Other methods of coupling the disposable loading units to the end of theelongated shaft may be employed. For example, as shown in FIGS. 80 and81, disposable loading unit 3612″ can include connector portion 3613which can be configured to be engaged with connector portion 3740 of theelongated shaft 3700″. In at least one embodiment, connector portion3613 can include at least one projection and/or groove which can bemated with at least one projection and/or groove of connector portion3740. In at least one such embodiment, the connector portions caninclude co-operating dovetail portions. In various embodiments, theconnector portions can be configured to interlock with one another andprevent, or at least inhibit, distal and/or proximal movement ofdisposable loading unit 3612″ along axis 3741. In at least oneembodiment, the distal end of the axial drive assembly 3680′ can includeaperture 3681 which can be configured to receive projection 3721extending from control rod 3720′. In various embodiments, such anarrangement can allow disposable loading unit 3612″ to be assembled toelongated shaft 3700 in a direction which is not collinear with orparallel to axis 3741. Although not illustrated, axial drive assembly3680′ and control rod 3720 can include any other suitable arrangement ofprojections and apertures to operably connect them to each other. Alsoin this embodiment, the first articulation link 3710 which can beoperably engaged with second articulation link 3690.

As can be seen in FIGS. 69 and 82, the surgical tool 3600 includes atool mounting portion 3750. The tool mounting portion 3750 includes atool mounting plate 3751 that is configured for attachment to the tooldrive assembly 1010. The tool mounting portion operably supported atransmission arrangement 3752 thereon. In use, it may be desirable torotate the disposable loading unit 3612 about the longitudinal tool axisdefined by the elongated shaft 3700. In at least one embodiment, thetransmission arrangement 3752 includes a rotational transmissionassembly 3753 that is configured to receive a corresponding rotaryoutput motion from the tool drive assembly 1010 of the robotic system1000 and convert that rotary output motion to a rotary control motionfor rotating the elongated shaft 3700 (and the disposable loading unit3612) about the longitudinal tool axis LT-LT. As can be seen in FIG. 82,a proximal end 3701 of the elongated shaft 3700 is rotatably supportedwithin a cradle arrangement 3754 that is attached to the tool mountingplate 3751 of the tool mounting portion 3750. A rotation gear 3755 isformed on or attached to the proximal end 3701 of the elongated shaft3700 for meshing engagement with a rotation gear assembly 3756 operablysupported on the tool mounting plate 3751. In at least one embodiment, arotation drive gear 3757 drivingly coupled to a corresponding first oneof the driven discs or elements 1304 on the adapter side of the toolmounting plate 3751 when the tool mounting portion 3750 is coupled tothe tool drive assembly 1010. The rotation transmission assembly 3753further comprises a rotary driven gear 3758 that is rotatably supportedon the tool mounting plate 3751 in meshing engagement with the rotationgear 3755 and the rotation drive gear 3757. Application of a firstrotary output motion from the robotic system 1000 through the tool driveassembly 1010 to the corresponding driven element 1304 will therebycause rotation of the rotation drive gear 3757 by virtue of beingoperably coupled thereto. Rotation of the rotation drive gear 3757ultimately results in the rotation of the elongated shaft 3700 (and thedisposable loading unit 3612) about the longitudinal tool axis LT-LT(primary rotary motion).

As can be seen in FIG. 82, a drive shaft assembly 3760 is coupled to aproximal end of the control rod 2720. In various embodiments, thecontrol rod 2720 is axially advanced in the distal and proximaldirections by a knife/closure drive transmission 3762. One form of theknife/closure drive assembly 3762 comprises a rotary drive gear 3763that is coupled to a corresponding second one of the driven rotatablebody portions, discs or elements 1304 on the adapter side of the toolmounting plate 3751 when the tool mounting portion 3750 is coupled tothe tool holder 1270. The rotary driven gear 3763 is in meshing drivingengagement with a gear train, generally depicted as 3764. In at leastone form, the gear train 3764 further comprises a first rotary drivengear assembly 3765 that is rotatably supported on the tool mountingplate 3751. The first rotary driven gear assembly 3765 is in meshingengagement with a second rotary driven gear assembly 3766 that isrotatably supported on the tool mounting plate 3751 and which is inmeshing engagement with a third rotary driven gear assembly 3767 that isin meshing engagement with a threaded portion 3768 of the drive shaftassembly 3760. Rotation of the rotary drive gear 3763 in a second rotarydirection will result in the axial advancement of the drive shaftassembly 3760 and control rod 2720 in the distal direction “DD”.Conversely, rotation of the rotary drive gear 3763 in a secondary rotarydirection which is opposite to the second rotary direction will causethe drive shaft assembly 3760 and the control rod 2720 to move in theproximal direction. When the control rod 2720 moves in the distaldirection, it drives the drive beam 3682 and the working head 3684thereof distally through the surgical staple cartridge 3640. As theworking head 3684 is driven distally, it operably engages the anvil 3620to pivot it to a closed position.

The cartridge carrier 3630 may be selectively articulated aboutarticulation axis AA-AA by applying axial articulation control motionsto the first and second articulation links 3710 and 3690. In variousembodiments, the transmission arrangement 3752 further includes anarticulation drive 3770 that is operably supported on the tool mountingplate 3751. More specifically and with reference to FIG. 82, it can beseen that a proximal end portion 3772 of an articulation drive shaft3771 configured to operably engage with the first articulation link 3710extends through the rotation gear 3755 and is rotatably coupled to ashifter rack gear 3774 that is slidably affixed to the tool mountingplate 3751 through slots 3775. The articulation drive 3770 furthercomprises a shifter drive gear 3776 that is coupled to a correspondingthird one of the driven discs or elements 1304 on the adapter side ofthe tool mounting plate 3751 when the tool mounting portion 3750 iscoupled to the tool holder 1270. The articulation drive assembly 3770further comprises a shifter driven gear 3778 that is rotatably supportedon the tool mounting plate 3751 in meshing engagement with the shifterdrive gear 3776 and the shifter rack gear 3774. Application of a thirdrotary output motion from the robotic system 1000 through the tool driveassembly 1010 to the corresponding driven element 1304 will therebycause rotation of the shifter drive gear 3776 by virtue of beingoperably coupled thereto. Rotation of the shifter drive gear 3776ultimately results in the axial movement of the shifter gear rack 3774and the articulation drive shaft 3771. The direction of axial travel ofthe articulation drive shaft 3771 depends upon the direction in whichthe shifter drive gear 3776 is rotated by the robotic system 1000. Thus,rotation of the shifter drive gear 3776 in a first rotary direction willresult in the axial movement of the articulation drive shaft 3771 in theproximal direction “PD” and cause the cartridge carrier 3630 to pivot ina first direction about articulation axis AA-AA. Conversely, rotation ofthe shifter drive gear 3776 in a second rotary direction (opposite tothe first rotary direction) will result in the axial movement of thearticulation drive shaft 3771 in the distal direction “DD” to therebycause the cartridge carrier 3630 to pivot about articulation axis AA-AAin an opposite direction.

FIG. 83 illustrates yet another surgical tool 3800 embodiment of thepresent invention that may be employed with a robotic system 1000. Ascan be seen in FIG. 83, the surgical tool 3800 includes a surgical endeffector 3812 in the form of an endocutter 3814 that employs variouscable-driven components. Various forms of cable driven endocutters aredisclosed, for example, in U.S. Pat. No. 7,726,537, entitled SURGICALSTAPLER WITH UNIVERSAL ARTICULATION AND TISSUE PRE-CLAMP and U.S. PatentApplication Publication No. US 2008/0308603, entitled CABLE ATTACHMENTARRANGEMENT FOR ATTACHING A CABLE TO A SURGICAL INSTRUMENT, thedisclosures of each are herein incorporated by reference in theirrespective entireties. Such endocutters 3814 may be referred to as a“disposable loading unit” because they are designed to be disposed ofafter a single use. However, the various unique and novel arrangementsof various embodiments of the present invention may also be employed inconnection with cable driven end effectors that are reusable.

As can be seen in FIG. 83, in at least one form, the endocutter 3814includes an elongated channel 3822 that operably supports a surgicalstaple cartridge 3834 therein. An anvil 3824 is pivotally supported formovement relative to the surgical staple cartridge 3834. The anvil 3824has a cam surface 3825 that is configured for interaction with apreclamping collar 3840 that is supported for axial movement relativethereto. The end effector 3814 is coupled to an elongated shaft assembly3808 that is attached to a tool mounting portion 3900. In variousembodiments, a closure cable 3850 is employed to move pre-clampingcollar 3840 distally onto and over cam surface 3825 to close the anvil3824 relative to the surgical staple cartridge 3834 and compress thetissue therebetween. Preferably, closure cable 3850 attaches to thepre-clamping collar 3840 at or near point 3841 and is fed through apassageway in anvil 3824 (or under a proximal portion of anvil 3824) andfed proximally through shaft 3808. Actuation of closure cable 3850 inthe proximal direction “PD” forces pre-clamping collar 3840 distallyagainst cam surface 3825 to close anvil 3824 relative to staplecartridge assembly 3834. A return mechanism, e.g., a spring, cablesystem or the like, may be employed to return pre-clamping collar 3840to a pre-clamping orientation which re-opens the anvil 3824.

The elongated shaft assembly 3808 may be cylindrical in shape and definea channel 3811 which may be dimensioned to receive a tube adapter 3870.See FIG. 84. In various embodiments, the tube adapter 3870 may beslidingly received in friction-fit engagement with the internal channelof elongated shaft 3808. The outer surface of the tube adapter 3870 mayfurther include at least one mechanical interface, e.g., a cutout ornotch 3871, oriented to mate with a corresponding mechanical interface,e.g., a radially inwardly extending protrusion or detent (not shown),disposed on the inner periphery of internal channel 3811 to lock thetube adapter 3870 to the elongated shaft 3808. In various embodiments,the distal end of tube adapter 3870 may include a pair of opposingflanges 3872 a and 3872 b which define a cavity for pivotably receivinga pivot block 3873 therein. Each flange 3872 a and 3872 b may include anaperture 3874 a and 3874 b that is oriented to receive a pivot pin 3875that extends through an aperture in pivot block 3873 to allow pivotablemovement of pivot block 3873 about an axis that is perpendicular tolongitudinal tool axis “LT-LT”. The channel 3822 may be formed with twoupwardly extending flanges 3823 a, 3823 b that have apertures therein,which are dimensioned to receive a pivot pin 3827. In turn, pivot pin3875 mounts through apertures in pivot block 3873 to permit rotation ofthe surgical end effector 3814 about the “Y” axis as needed during agiven surgical procedure. Rotation of pivot block 3873 about pin 3875along “Z” axis rotates the surgical end effector 3814 about the “Z”axis. See FIG. 84. Other methods of fastening the elongated channel 3822to the pivot block 3873 may be effectively employed without departingfrom the spirit and scope of the present invention.

The surgical staple cartridge 3834 can be assembled and mounted withinthe elongated channel 3822 during the manufacturing or assembly processand sold as part of the surgical end effector 3812, or the surgicalstaple cartridge 3834 may be designed for selective mounting within theelongated channel 3822 as needed and sold separately, e.g., as a singleuse replacement, replaceable or disposable staple cartridge assembly. Itis within the scope of this disclosure that the surgical end effector3812 may be pivotally, operatively, or integrally attached, for example,to distal end 3809 of the elongated shaft assembly 3808 of a disposablesurgical stapler. As is known, a used or spent disposable loading unit3814 can be removed from the elongated shaft assembly 3808 and replacedwith an unused disposable unit. The endocutter 3814 may also preferablyinclude an actuator, preferably a dynamic clamping member 3860, a sled3862, as well as staple pushers (not shown) and staples (not shown) oncean unspent or unused cartridge 3834 is mounted in the elongated channel3822. See FIG. 84.

In various embodiments, the dynamic clamping member 3860 is associatedwith, e.g., mounted on and rides on, or with or is connected to orintegral with and/or rides behind sled 3862. It is envisioned thatdynamic clamping member 3860 can have cam wedges or cam surfacesattached or integrally formed or be pushed by a leading distal surfacethereof. In various embodiments, dynamic clamping member 3860 mayinclude an upper portion 3863 having a transverse aperture 3864 with apin 3865 mountable or mounted therein, a central support or upwardextension 3866 and substantially T-shaped bottom flange 3867 whichcooperate to slidingly retain dynamic clamping member 3860 along anideal cutting path during longitudinal, distal movement of sled 3862.The leading cutting edge 3868, here, knife blade 3869, is dimensioned toride within slot 3835 of staple cartridge assembly 3834 and separatetissue once stapled. As used herein, the term “knife assembly” mayinclude the aforementioned dynamic clamping member 3860, knife 3869, andsled 3862 or other knife/beam/sled drive arrangements and cuttinginstrument arrangements. In addition, the various embodiments of thepresent invention may be employed with knife assembly/cutting instrumentarrangements that may be entirely supported in the staple cartridge 3834or partially supported in the staple cartridge 3834 and elongatedchannel 3822 or entirely supported within the elongated channel 3822.

In various embodiments, the dynamic clamping member 3860 may be drivenin the proximal and distal directions by a cable drive assembly 3870. Inone non-limiting form, the cable drive assembly comprises a pair ofadvance cables 3880, 3882 and a firing cable 3884. FIGS. 85 and 86illustrate the cables 3880, 3882, 3884 in diagrammatic form. As can beseen in those Figures, a first advance cable 3880 is operably supportedon a first distal cable transition support 3885 which may comprise, forexample, a pulley, rod, capstan, etc. that is attached to the distal endof the elongated channel 3822 and a first proximal cable transitionsupport 3886 which may comprise, for example, a pulley, rod, capstan,etc. that is operably supported by the elongated channel 3822. A distalend 3881 of the first advance cable 3880 is affixed to the dynamicclamping assembly 3860. The second advance cable 3882 is operablysupported on a second distal cable transition support 3887 which may,for example, comprise a pulley, rod, capstan etc. that is mounted to thedistal end of the elongated channel 3822 and a second proximal cabletransition support 3888 which may, for example, comprise a pulley, rod,capstan, etc. mounted to the proximal end of the elongated channel 3822.The proximal end 3883 of the second advance cable 3882 may be attachedto the dynamic clamping assembly 3860. Also in these embodiments, anendless firing cable 3884 is employed and journaled on a support 3889that may comprise a pulley, rod, capstan, etc. mounted within theelongated shaft 3808. In one embodiment, the retract cable 3884 may beformed in a loop and coupled to a connector 3889′ that is fixedlyattached to the first and second advance cables 3880, 3882.

Various non-limiting embodiments of the present invention include acable drive transmission 3920 that is operably supported on a toolmounting plate 3902 of the tool mounting portion 3900. The tool mountingportion 3900 has an array of electrical connecting pins 3904 which areconfigured to interface with the slots 1258 (FIG. 25) in the adapter1240′. Such arrangement permits the robotic system 1000 to providecontrol signals to a control circuit 3910 of the tool 3800. While theinterface is described herein with reference to mechanical, electrical,and magnetic coupling elements, it should be understood that a widevariety of telemetry modalities might be used, including infrared,inductive coupling, or the like.

Control circuit 3910 is shown in schematic form in FIG. 83. In one formor embodiment, the control circuit 3910 includes a power supply in theform of a battery 3912 that is coupled to an on-off solenoid poweredswitch 3914. In other embodiments, however, the power supply maycomprise a source of alternating current. Control circuit 3910 furtherincludes an on/off solenoid 3916 that is coupled to a double pole switch3918 for controlling motor rotation direction. Thus, when the roboticsystem 1000 supplies an appropriate control signal, switch 3914 willpermit battery 3912 to supply power to the double pole switch 3918. Therobotic system 1000 will also supply an appropriate signal to the doublepole switch 3918 to supply power to a shifter motor 3922.

Turning to FIGS. 87-92, at least one embodiment of the cable drivetransmission 3920 comprises a drive pulley 3930 that is operably mountedto a drive shaft 3932 that is attached to a driven element 1304 of thetype and construction described above that is designed to interface witha corresponding drive element 1250 of the adapter 1240. See FIGS. 25 and90. Thus, when the tool mounting portion 3900 is operably coupled to thetool holder 1270, the robot system 1000 can apply rotary motion to thedrive pulley 3930 in a desired direction. A first drive member or belt3934 drivingly engages the drive pulley 3930 and a second drive shaft3936 that is rotatably supported on a shifter yoke 3940. The shifteryoke 3940 is operably coupled to the shifter motor 3922 such thatrotation of the shaft 3923 of the shifter motor 3922 in a firstdirection will shift the shifter yoke in a first direction “FD” androtation of the shifter motor shaft 3923 in a second direction willshift the shifter yoke 3940 in a second direction “SD”. Otherembodiments of the present invention may employ a shifter solenoidarrangement for shifting the shifter yoke in said first and seconddirections.

As can be seen in FIGS. 87-90, a closure drive gear 3950 mounted to asecond drive shaft 3936 and is configured to selectively mesh with aclosure drive assembly, generally designated as 3951. Likewise a firingdrive gear 3960 is also mounted to the second drive shaft 3936 and isconfigured to selectively mesh with a firing drive assembly generallydesignated as 3961. Rotation of the second drive shaft 3936 causes theclosure drive gear 3950 and the firing drive gear 3960 to rotate. In onenon-limiting embodiment, the closure drive assembly 3951 comprises aclosure driven gear 3952 that is coupled to a first closure pulley 3954that is rotatably supported on a third drive shaft 3956. The closurecable 3850 is drivingly received on the first closure pulley 3954 suchthat rotation of the closure driven gear 3952 will drive the closurecable 3850. Likewise, the firing drive assembly 3961 comprises a firingdriven gear 3962 that is coupled to a first firing pulley 3964 that isrotatably supported on the third drive shaft 3956. The first and seconddriving pulleys 3954 and 3964 are independently rotatable on the thirddrive shaft 3956. The firing cable 3884 is drivingly received on thefirst firing pulley 3964 such that rotation of the firing driven gear3962 will drive the firing cable 3884.

Also in various embodiments, the cable drive transmission 3920 furtherincludes a braking assembly 3970. In at least one embodiment, forexample, the braking assembly 3970 includes a closure brake 3972 thatcomprises a spring arm 3973 that is attached to a portion of thetransmission housing 3971. The closure brake 3972 has a gear lug 3974that is sized to engage the teeth of the closure driven gear 3952 aswill be discussed in further detail below. The braking assembly 3970further includes a firing brake 3976 that comprises a spring arm 3977that is attached to another portion of the transmission housing 3971.The firing brake 3976 has a gear lug 3978 that is sized to engage theteeth of the firing driven gear 3962.

At least one embodiment of the surgical tool 3800 may be used asfollows. The tool mounting portion 3900 is operably coupled to theinterface 1240 of the robotic system 1000. The controller or controlunit of the robotic system is operated to locate the tissue to be cutand stapled between the open anvil 3824 and the staple cartridge 3834.When in that initial position, the braking assembly 3970 has locked theclosure driven gear 3952 and the firing driven gear 3962 such that theycannot rotate. That is, as shown in FIG. 88, the gear lug 3974 is inlocking engagement with the closure driven gear 3952 and the gear lug3978 is in locking engagement with the firing driven gear 3962. Once thesurgical end effector 3814 has been properly located, the controller1001 of the robotic system 1000 will provide a control signal to theshifter motor 3922 (or shifter solenoid) to move the shifter yoke 3940in the first direction. As the shifter yoke 3940 is moved in the firstdirection, the closure drive gear 3950 moves the gear lug 3974 out ofengagement with the closure driven gear 3952 as it moves into meshingengagement with the closure driven gear 3952. As can be seen in FIG. 87,when in that position, the gear lug 3978 remains in locking engagementwith the firing driven gear 3962 to prevent actuation of the firingsystem. Thereafter, the robotic controller 1001 provides a first rotaryactuation motion to the drive pulley 3930 through the interface betweenthe driven element 1304 and the corresponding components of the toolholder 1240. As the drive pulley 3930 is rotated in the first direction,the closure cable 3850 is rotated to drive the preclam ping collar 3840into closing engagement with the cam surface 3825 of the anvil 3824 tomove it to the closed position thereby clamping the target tissuebetween the anvil 3824 and the staple cartridge 3834. See FIG. 83. Oncethe anvil 3824 has been moved to the closed position, the roboticcontroller 1001 stops the application of the first rotary motion to thedrive pulley 3930. Thereafter, the robotic controller 1001 may commencethe firing process by sending another control signal to the shiftermotor 3922 (or shifter solenoid) to cause the shifter yoke to move inthe second direction “SD” as shown in FIG. 94. As the shifter yoke 3940is moved in the second direction, the firing drive gear 3960 moves thegear lug 3978 out of engagement with the firing driven gear 3962 as itmoves into meshing engagement with the firing driven gear 3962. As canbe seen in FIG. 89, when in that position, the gear lug 3974 remains inlocking engagement with the closure driven gear 3952 to preventactuation of the closure system. Thereafter, the robotic controller 1001is activated to provide the first rotary actuation motion to the drivepulley 3930 through the interface between the driven element 1304 andthe corresponding components of the tool holder 1240. As the drivepulley 3930 is rotated in the first direction, the firing cable 3884 isrotated to drive the dynamic clamping member 3860 in the distaldirection “DD” thereby firing the stapes and cutting the tissue clampedin the end effector 3814. Once the robotic system 1000 determines thatthe dynamic clamping member 3860 has reached its distal mostposition—either through sensors or through monitoring the amount ofrotary input applied to the drive pulley 3930, the controller 1001 maythen apply a second rotary motion to the drive pulley 3930 to rotate theclosure cable 3850 in an opposite direction to cause the dynamicclamping member 3860 to be retracted in the proximal direction “PD”.Once the dynamic clamping member has been retracted to the startingposition, the application of the second rotary motion to the drivepulley 3930 is discontinued. Thereafter, the shifter motor 3922 (orshifter solenoid) is powered to move the shifter yoke 3940 to theclosure position (FIG. 92.). Once the closure drive gear 3950 is inmeshing engagement with the closure driven gear 3952, the roboticcontroller 1001 may once again apply the second rotary motion to thedrive pulley 3930. Rotation of the drive pulley 3930 in the seconddirection causes the closure cable 3850 to retract the preclampingcollar 3840 out of engagement with the cam surface 3825 of the anvil3824 to permit the anvil 3824 to move to an open position (by a springor other means) to release the stapled tissue from the surgical endeffector 3814.

FIG. 93 illustrates a surgical tool 4000 that employs a gear drivenfiring bar 4092 as shown in FIGS. 94-96. This embodiment includes anelongated shaft assembly 4008 that extends from a tool mounting portion4100. The tool mounting portion 4100 includes a tool mounting plate 4102that operable supports a transmission arrangement 4103 thereon. Theelongated shaft assembly 4008 includes a rotatable proximal closure tube4010 that is rotatably journaled on a proximal spine member 4020 that isrigidly coupled to the tool mounting plate 4102. The proximal spinemember 4020 has a distal end that is coupled to an elongated channelportion 4022 of a surgical end effector 4012. The surgical effector 4012may be substantially similar to surgical end effector 3412 describedabove. In addition, the anvil 4024 of the surgical end effector 4012 maybe opened and closed by a distal closure tube 4030 that operablyinterfaces with the proximal closure tube 4010. Distal closure tube 4030is identical to distal closure tube 3430 described above. Similarly,proximal closure tube 4010 is identical to proximal closure tube segment3410 described above.

Anvil 4024 is opened and closed by rotating the proximal closure tube4010 in manner described above with respect to distal closure tube 3410.In at least one embodiment, the transmission arrangement comprises aclosure transmission, generally designated as 4011. As will be furtherdiscussed below, the closure transmission 4011 is configured to receivea corresponding first rotary motion from the robotic system 1000 andconvert that first rotary motion to a primary rotary motion for rotatingthe rotatable proximal closure tube 4010 about the longitudinal toolaxis LT-LT. As can be seen in FIG. 96, a proximal end 4060 of theproximal closure tube 4010 is rotatably supported within a cradlearrangement 4104 that is attached to a tool mounting plate 4102 of thetool mounting portion 4100. A rotation gear 4062 is formed on orattached to the proximal end 4060 of the closure tube segment 4010 formeshing engagement with a rotation drive assembly 4070 that is operablysupported on the tool mounting plate 4102. In at least one embodiment, arotation drive gear 4072 is coupled to a corresponding first one of thedriven discs or elements 1304 on the adapter side of the tool mountingplate 4102 when the tool mounting portion 4100 is coupled to thetoolholder 1270. See FIGS. 26 and 96. The rotation drive assembly 4070further comprises a rotary driven gear 4074 that is rotatably supportedon the tool mounting plate 4102 in meshing engagement with the rotationgear 4062 and the rotation drive gear 4072. Application of a firstrotary control motion from the robotic system 1000 through the toolholder 1270 and the adapter 1240 to the corresponding driven element1304 will thereby cause rotation of the rotation drive gear 4072 byvirtue of being operably coupled thereto. Rotation of the rotation drivegear 4072 ultimately results in the rotation of the closure tube segment4010 to open and close the anvil 4024 as described above.

As indicated above, the end effector 4012 employs a cutting element 3860as shown in FIGS. 94 and 95. In at least one non-limiting embodiment,the transmission arrangement 4103 further comprises a knife drivetransmission that includes a knife drive assembly 4080. FIG. 96illustrates one form of knife drive assembly 4080 for axially advancingthe knife bar 4092 that is attached to such cutting element using cablesas described above with respect to surgical tool 3800. In particular,the knife bar 4092 replaces the firing cable 3884 employed in anembodiment of surgical tool 3800. One form of the knife drive assembly4080 comprises a rotary drive gear 4082 that is coupled to acorresponding second one of the driven discs or elements 1304 on theadapter side of the tool mounting plate 4102 when the tool mountingportion 4100 is coupled to the tool holder 1270. See FIGS. 26 and 96.The knife drive assembly 4080 further comprises a first rotary drivengear assembly 4084 that is rotatably supported on the tool mountingplate 4102. The first rotary driven gear assembly 4084 is in meshingengagement with a third rotary driven gear assembly 4086 that isrotatably supported on the tool mounting plate 4102 and which is inmeshing engagement with a fourth rotary driven gear assembly 4088 thatis in meshing engagement with a threaded portion 4094 of drive shaftassembly 4090 that is coupled to the knife bar 4092. Rotation of therotary drive gear 4082 in a second rotary direction will result in theaxial advancement of the drive shaft assembly 4090 and knife bar 4092 inthe distal direction “DD”. Conversely, rotation of the rotary drive gear4082 in a secondary rotary direction (opposite to the second rotarydirection) will cause the drive shaft assembly 4090 and the knife bar4092 to move in the proximal direction. Movement of the firing bar 4092in the proximal direction “PD” will drive the cutting element 3860 inthe distal direction “DD”. Conversely, movement of the firing bar 4092in the distal direction “DD” will result in the movement of the cuttingelement 3860 in the proximal direction “PD”.

FIGS. 97-103 illustrate yet another surgical tool 5000 that may beeffectively employed in connection with a robotic system 1000. Invarious forms, the surgical tool 5000 includes a surgical end effector5012 in the form of a surgical stapling instrument that includes anelongated channel 5020 and a pivotally translatable clamping member,such as an anvil 5070, which are maintained at a spacing that assureseffective stapling and severing of tissue clamped in the surgical endeffector 5012. As can be seen in FIG. 99, the elongated channel 5020 maybe substantially U-shaped in cross-section and be fabricated from, forexample, titanium, 203 stainless steel, 304 stainless steel, 416stainless steel, 17-4 stainless steel, 17-7 stainless steel, 6061 or7075 aluminum, chromium steel, ceramic, etc. A substantially U-shapedmetal channel pan 5022 may be supported in the bottom of the elongatedchannel 5020 as shown.

Various embodiments include an actuation member in the form of a sledassembly 5030 that is operably supported within the surgical endeffector 5012 and axially movable therein between a starting positionand an ending position in response to control motions applied thereto.In some forms, the metal channel pan 5022 has a centrally-disposed slot5024 therein to movably accommodate a base portion 5032 of the sledassembly 5030. The base portion 5032 includes a foot portion 5034 thatis sized to be slidably received in a slot 5021 in the elongated channel5020. See FIG. 104. As can be seen in FIGS. 98, 99, 102, and 103, thebase portion 5032 of sled assembly 5030 includes an axially extendingthreaded bore 5036 that is configured to be threadedly received on athreaded drive shaft 5130 as will be discussed in further detail below.In addition, the sled assembly 5030 includes an upstanding supportportion 5038 that supports a tissue cutting blade or tissue cuttinginstrument 5040. The upstanding support portion 5038 terminates in a topportion 5042 that has a pair of laterally extending retaining fins 5044protruding therefrom. As shown in FIG. 99, the fins 5044 are positionedto be received within corresponding slots 5072 in anvil 5070. The fins5044 and the foot 5034 serve to retain the anvil 5070 in a desiredspaced closed position as the sled assembly 5030 is driven distallythrough the tissue clamped within the surgical end effector 5014. As canalso be seen in FIGS. 101 and 103, the sled assembly 5030 furtherincludes a reciprocatably or sequentially activatable drive assembly5050 for driving staple pushers toward the closed anvil 5070.

More specifically and with reference to FIGS. 99 and 100, the elongatedchannel 5020 is configured to operably support a surgical staplecartridge 5080 therein. In at least one form, the surgical staplecartridge 5080 comprises a body portion 5082 that may be fabricatedfrom, for example, Vectra, Nylon (6/6 or 6/12) and include a centrallydisposed slot 5084 for accommodating the upstanding support portion 5038of the sled assembly 5030. See FIG. 99. These materials could also befilled with glass, carbon, or mineral fill of 10%-40%. The surgicalstaple cartridge 5080 further includes a plurality of cavities 5086 formovably supporting lines or rows of staple-supporting pushers 5088therein. The cavities 5086 may be arranged in spaced longitudinallyextending lines or rows 5090, 5092, 5094, 5096. For example, the rows5090 may be referred to herein as first outboard rows. The rows 5092 maybe referred to herein as first inboard rows. The rows 5094 may bereferred to as second inboard rows and the rows 5096 may be referred toas second outboard rows. The first inboard row 5090 and the firstoutboard row 5092 are located on a first lateral side of thelongitudinal slot 5084 and the second inboard row 5094 and the secondoutboard row 5096 are located on a second lateral side of thelongitudinal slot 5084. The first staple pushers 5088 in the firstinboard row 5092 are staggered in relationship to the first staplepushers 5088 in the first outboard row 5090. Similarly, the secondstaple pushers 5088 in the second outboard row 5096 are staggered inrelationship to the second pushers 5088 in the second inboard row 5094.Each pusher 5088 operably supports a surgical staple 5098 thereon.

In various embodiments, the sequentially-activatable orreciprocatably—activatable drive assembly 5050 includes a pair ofoutboard drivers 5052 and a pair of inboard drivers 5054 that are eachattached to a common shaft 5056 that is rotatably mounted within thebase 5032 of the sled assembly 5030. The outboard drivers 5052 areoriented to sequentially or reciprocatingly engage a correspondingplurality of outboard activation cavities 5026 provided in the channelpan 5022. Likewise, the inboard drivers 5054 are oriented tosequentially or reciprocatingly engage a corresponding plurality ofinboard activation cavities 5028 provided in the channel pan 5022. Theinboard activation cavities 5028 are arranged in a staggeredrelationship relative to the adjacent outboard activation cavities 5026.See FIG. 100. As can also be seen in FIGS. 100 and 102, in at least oneembodiment, the sled assembly 5030 further includes distal wedgesegments 5060 and intermediate wedge segments 5062 located on each sideof the bore 5036 to engage the pushers 5088 as the sled assembly 5030 isdriven distally in the distal direction “DD”. As indicated above, thesled assembly 5030 is threadedly received on a threaded portion 5132 ofa drive shaft 5130 that is rotatably supported within the end effector5012. In various embodiments, for example, the drive shaft 5130 has adistal end 5134 that is supported in a distal bearing 5136 mounted inthe surgical end effector 5012. See FIGS. 99 and 100.

In various embodiments, the surgical end effector 5012 is coupled to atool mounting portion 5200 by an elongated shaft assembly 5108. In atleast one embodiment, the tool mounting portion 5200 operably supports atransmission arrangement generally designated as 5204 that is configuredto receive rotary output motions from the robotic system. The elongatedshaft assembly 5108 includes an outer closure tube 5110 that isrotatable and axially movable on a spine member 5120 that is rigidlycoupled to a tool mounting plate 5201 of the tool mounting portion 5200.The spine member 5120 also has a distal end 5122 that is coupled to theelongated channel portion 5020 of the surgical end effector 5012.

In use, it may be desirable to rotate the surgical end effector 5012about a longitudinal tool axis LT-LT defined by the elongated shaftassembly 5008. In various embodiments, the outer closure tube 5110 has aproximal end 5112 that is rotatably supported on the tool mounting plate5201 of the tool drive portion 5200 by a forward support cradle 5203.The proximal end 5112 of the outer closure tube 5110 is configured tooperably interface with a rotation transmission portion 5206 of thetransmission arrangement 5204. In various embodiments, the proximal end5112 of the outer closure tube 5110 is also supported on a closure sled5140 that is also movably supported on the tool mounting plate 5201. Aclosure tube gear segment 5114 is formed on the proximal end 5112 of theouter closure tube 5110 for meshing engagement with a rotation driveassembly 5150 of the rotation transmission 5206. As can be seen in FIG.97, the rotation drive assembly 5150, in at least one embodiment,comprises a rotation drive gear 5152 that is coupled to a correspondingfirst one of the driven discs or elements 1304 on the adapter side 1307of the tool mounting plate 5201 when the tool drive portion 5200 iscoupled to the tool holder 1270. The rotation drive assembly 5150further comprises a rotary driven gear 5154 that is rotatably supportedon the tool mounting plate 5201 in meshing engagement with the closuretube gear segment 5114 and the rotation drive gear 5152. Application ofa first rotary control motion from the robotic system 1000 through thetool holder 1270 and the adapter 1240 to the corresponding drivenelement 1304 will thereby cause rotation of the rotation drive gear5152. Rotation of the rotation drive gear 5152 ultimately results in therotation of the elongated shaft assembly 5108 (and the end effector5012) about the longitudinal tool axis LT-LT (represented by arrow “R”in FIG. 97).

Closure of the anvil 5070 relative to the surgical staple cartridge 5080is accomplished by axially moving the outer closure tube 5110 in thedistal direction “DD”. Such axial movement of the outer closure tube5110 may be accomplished by a closure transmission portion 5144 of thetransmission arrangement 5204. As indicated above, in variousembodiments, the proximal end 5112 of the outer closure tube 5110 issupported by the closure sled 5140 which enables the proximal end 5112to rotate relative thereto, yet travel axially with the closure sled5140. In particular, as can be seen in FIG. 97, the closure sled 5140has an upstanding tab 5141 that extends into a radial groove 5115 in theproximal end portion 5112 of the outer closure tube 5110. In addition,as was described above, the closure sled 5140 is slidably mounted to thetool mounting plate 5201. In various embodiments, the closure sled 5140has an upstanding portion 5142 that has a closure rack gear 5143 formedthereon. The closure rack gear 5143 is configured for driving engagementwith the closure transmission 5144.

In various forms, the closure transmission 5144 includes a closure spurgear 5145 that is coupled to a corresponding second one of the drivendiscs or elements 1304 on the adapter side 1307 of the tool mountingplate 5201. Thus, application of a second rotary control motion from therobotic system 1000 through the tool holder 1270 and the adapter 1240 tothe corresponding second driven element 1304 will cause rotation of theclosure spur gear 5145 when the interface 1230 is coupled to the toolmounting portion 5200. The closure transmission 5144 further includes adriven closure gear set 5146 that is supported in meshing engagementwith the closure spur gear 5145 and the closure rack gear 5143. Thus,application of a second rotary control motion from the robotic system1000 through the tool holder 1270 and the adapter 1240 to thecorresponding second driven element 1304 will cause rotation of theclosure spur gear 5145 and ultimately drive the closure sled 5140 andthe outer closure tube 5110 axially. The axial direction in which theclosure tube 5110 moves ultimately depends upon the direction in whichthe second driven element 1304 is rotated. For example, in response toone rotary closure motion received from the robotic system 1000, theclosure sled 5140 will be driven in the distal direction “DD” andultimately the outer closure tube 5110 will be driven in the distaldirection as well. The outer closure tube 5110 has an opening 5117 inthe distal end 5116 that is configured for engagement with a tab 5071 onthe anvil 5070 in the manners described above. As the outer closure tube5110 is driven distally, the proximal end 5116 of the closure tube 5110will contact the anvil 5070 and pivot it closed. Upon application of an“opening” rotary motion from the robotic system 1000, the closure sled5140 and outer closure tube 5110 will be driven in the proximaldirection “PD” and pivot the anvil 5070 to the open position in themanners described above.

In at least one embodiment, the drive shaft 5130 has a proximal end 5137that has a proximal shaft gear 5138 attached thereto. The proximal shaftgear 5138 is supported in meshing engagement with a distal drive gear5162 attached to a rotary drive bar 5160 that is rotatably supportedwith spine member 5120. Rotation of the rotary drive bar 5160 andultimately rotary drive shaft 5130 is controlled by a rotary knifetransmission 5207 which comprises a portion of the transmissionarrangement 5204 supported on the tool mounting plate 5210. In variousembodiments, the rotary knife transmission 5207 comprises a rotary knifedrive system 5170 that is operably supported on the tool mounting plate5201. In various embodiments, the knife drive system 5170 includes arotary drive gear 5172 that is coupled to a corresponding third one ofthe driven discs or elements 1304 on the adapter side of the toolmounting plate 5201 when the tool drive portion 5200 is coupled to thetool holder 1270. The knife drive system 5170 further comprises a firstrotary driven gear 5174 that is rotatably supported on the tool mountingplate 5201 in meshing engagement with a second rotary driven gear 5176and the rotary drive gear 5172. The second rotary driven gear 5176 iscoupled to a proximal end portion 5164 of the rotary drive bar 5160.

Rotation of the rotary drive gear 5172 in a first rotary direction willresult in the rotation of the rotary drive bar 5160 and rotary driveshaft 5130 in a first direction. Conversely, rotation of the rotarydrive gear 5172 in a second rotary direction (opposite to the firstrotary direction) will cause the rotary drive bar 5160 and rotary driveshaft 5130 to rotate in a second direction. 2400. Thus, rotation of thedrive shaft 2440 results in rotation of the drive sleeve 2400.

One method of operating the surgical tool 5000 will now be described.The tool drive 5200 is operably coupled to the interface 1240 of therobotic system 1000. The controller 1001 of the robotic system 1000 isoperated to locate the tissue to be cut and stapled between the openanvil 5070 and the surgical staple cartridge 5080. Once the surgical endeffector 5012 has been positioned by the robot system 1000 such that thetarget tissue is located between the anvil 5070 and the surgical staplecartridge 5080, the controller 1001 of the robotic system 1000 may beactivated to apply the second rotary output motion to the second drivenelement 1304 coupled to the closure spur gear 5145 to drive the closuresled 5140 and the outer closure tube 5110 axially in the distaldirection to pivot the anvil 5070 closed in the manner described above.Once the robotic controller 1001 determines that the anvil 5070 has beenclosed by, for example, sensors in the surgical end effector 5012 and/orthe tool drive portion 5200, the robotic controller 1001 system mayprovide the surgeon with an indication that signifies the closure of theanvil. Such indication may be, for example, in the form of a lightand/or audible sound, tactile feedback on the control members, etc. Thenthe surgeon may initiate the firing process. In alternative embodiments,however, the robotic controller 1001 may automatically commence thefiring process.

To commence the firing process, the robotic controller applies a thirdrotary output motion to the third driven disc or element 1304 coupled tothe rotary drive gear 5172. Rotation of the rotary drive gear 5172results in the rotation of the rotary drive bar 5160 and rotary driveshaft 5130 in the manner described above. Firing and formation of thesurgical staples 5098 can be best understood from reference to FIGS. 98,100, and 101. As the sled assembly 5030 is driven in the distaldirection “DD” through the surgical staple cartridge 5080, the distalwedge segments 5060 first contact the staple pushers 5088 and start tomove them toward the closed anvil 5070. As the sled assembly 5030continues to move distally, the outboard drivers 5052 will drop into thecorresponding activation cavity 5026 in the channel pan 5022. Theopposite end of each outboard driver 5052 will then contact thecorresponding outboard pusher 5088 that has moved up the distal andintermediate wedge segments 5060, 5062. Further distal movement of thesled assembly 5030 causes the outboard drivers 5052 to rotate and drivethe corresponding pushers 5088 toward the anvil 5070 to cause thestaples 5098 supported thereon to be formed as they are driven into theanvil 5070. It will be understood that as the sled assembly 5030 movesdistally, the knife blade 5040 cuts through the tissue that is clampedbetween the anvil and the staple cartridge. Because the inboard drivers5054 and outboard drivers 5052 are attached to the same shaft 5056 andthe inboard drivers 5054 are radially offset from the outboard drivers5052 on the shaft 5056, as the outboard drivers 5052 are driving theircorresponding pushers 5088 toward the anvil 5070, the inboard drivers5054 drop into their next corresponding activation cavity 5028 to causethem to rotatably or reciprocatingly drive the corresponding inboardpushers 5088 towards the closed anvil 5070 in the same manner. Thus, thelaterally corresponding outboard staples 5098 on each side of thecentrally disposed slot 5084 are simultaneously formed together and thelaterally corresponding inboard staples 5098 on each side of the slot5084 are simultaneously formed together as the sled assembly 5030 isdriven distally. Once the robotic controller 1001 determines that thesled assembly 5030 has reached its distal most position—either throughsensors or through monitoring the amount of rotary input applied to thedrive shaft 5130 and/or the rotary drive bar 5160, the controller 1001may then apply a third rotary output motion to the drive shaft 5130 torotate the drive shaft 5130 in an opposite direction to retract the sledassembly 5030 back to its starting position. Once the sled assembly 5030has been retracted to the starting position (as signaled by sensors inthe end effector 5012 and/or the tool drive portion 5200), theapplication of the second rotary motion to the drive shaft 5130 isdiscontinued. Thereafter, the surgeon may manually activate the anvilopening process or it may be automatically commenced by the roboticcontroller 1001. To open the anvil 5070, the second rotary output motionis applied to the closure spur gear 5145 to drive the closure sled 5140and the outer closure tube 5110 axially in the proximal direction. Asthe closure tube 5110 moves proximally, the opening 5117 in the distalend 5116 of the closure tube 5110 contacts the tab 5071 on the anvil5070 to pivot the anvil 5070 to the open position. A spring may also beemployed to bias the anvil 5070 to the open position when the closuretube 5116 has been returned to the starting position. Again, sensors inthe surgical end effector 5012 and/or the tool mounting portion 5200 mayprovide the robotic controller 1001 with a signal indicating that theanvil 5070 is now open. Thereafter, the surgical end effector 5012 maybe withdrawn from the surgical site.

FIGS. 104-109 diagrammatically depict the sequential firing of staplesin a surgical tool assembly 5000′ that is substantially similar to thesurgical tool assembly 5000 described above. In this embodiment, theinboard and outboard drivers 5052′, 5054′ have a cam-like shape with acam surface 5053 and an actuator protrusion 5055 as shown in FIGS.104-110. The drivers 5052′, 5054′ are journaled on the same shaft 5056′that is rotatably supported by the sled assembly 5030′. In thisembodiment, the sled assembly 5030′ has distal wedge segments 5060′ forengaging the pushers 5088. FIG. 104 illustrates an initial position oftwo inboard or outboard drivers 5052′, 5054′ as the sled assembly 5030′is driven in the distal direction “DD”. As can be seen in that Figure,the pusher 5088 a has advanced up the wedge segment 5060′ and hascontacted the driver 5052′, 5054′. Further travel of the sled assembly5030′ in the distal direction causes the driver 5052′, 5054′ to pivot inthe “P” direction (FIG. 105) until the actuator portion 5055 contactsthe end wall 5029 a of the activation cavity 5026, 5028 as shown in FIG.111. Continued advancement of the sled assembly 5030′ in the distaldirection “DD” causes the driver 5052′, 5054′ to rotate in the “D”direction as shown in FIG. 107. As the driver 5052′, 5054′ rotates, thepusher 5088 a rides up the cam surface 5053 to the final verticalposition shown in FIG. 108. When the pusher 5088 a reaches the finalvertical position shown in FIGS. 108 and 109, the staple (not shown)supported thereon has been driven into the staple forming surface of theanvil to form the staple.

FIGS. 111-116 illustrate a surgical end effector 5312 that may beemployed for example, in connection with the tool mounting portion 1300and shaft 2008 described in detail above. In various forms, the surgicalend effector 5312 includes an elongated channel 5322 that is constructedas described above for supporting a surgical staple cartridge 5330therein. The surgical staple cartridge 5330 comprises a body portion5332 that includes a centrally disposed slot 5334 for accommodating anupstanding support portion 5386 of a sled assembly 5380. See FIGS.111-113. The surgical staple cartridge body portion 5332 furtherincludes a plurality of cavities 5336 for movably supportingstaple-supporting pushers 5350 therein. The cavities 5336 may bearranged in spaced longitudinally extending rows 5340, 5342, 5344, 5346.The rows 5340, 5342 are located on one lateral side of the longitudinalslot 5334 and the rows 5344, 5346 are located on the other side oflongitudinal slot 5334. In at least one embodiment, the pushers 5350 areconfigured to support two surgical staples 5352 thereon. In particular,each pusher 5350 located on one side of the elongated slot 5334 supportsone staple 5352 in row 5340 and one staple 5352 in row 5342 in astaggered orientation. Likewise, each pusher 5350 located on the otherside of the elongated slot 5334 supports one surgical staple 5352 in row5344 and another surgical staple 5352 in row 5346 in a staggeredorientation. Thus, every pusher 5350 supports two surgical staples 5352.

As can be further seen in FIGS. 111, 112, the surgical staple cartridge5330 includes a plurality of rotary drivers 5360. More particularly, therotary drivers 5360 on one side of the elongated slot 5334 are arrangedin a single line 5370 and correspond to the pushers 5350 in lines 5340,5342. In addition, the rotary drivers 5360 on the other side of theelongated slot 5334 are arranged in a single line 5372 and correspond tothe pushers 5350 in lines 5344, 5346. As can be seen in FIG. 116, eachrotary driver 5360 is rotatably supported within the staple cartridgebody 5332. More particularly, each rotary driver 5360 is rotatablyreceived on a corresponding driver shaft 5362. Each driver 5360 has anarcuate ramp portion 5364 formed thereon that is configured to engage anarcuate lower surface 5354 formed on each pusher 5350. See FIG. 116. Inaddition, each driver 5360 has a lower support portion 5366 extendtherefrom to slidably support the pusher 5360 on the channel 5322. Eachdriver 5360 has a downwardly extending actuation rod 5368 that isconfigured for engagement with a sled assembly 5380.

As can be seen in FIG. 113, in at least one embodiment, the sledassembly 5380 includes a base portion 5382 that has a foot portion 5384that is sized to be slidably received in a slot 5333 in the channel5322. See FIG. 111. The sled assembly 5380 includes an upstandingsupport portion 5386 that supports a tissue cutting blade or tissuecutting instrument 5388. The upstanding support portion 5386 terminatesin a top portion 5390 that has a pair of laterally extending retainingfins 5392 protruding therefrom. The fins 5392 are positioned to bereceived within corresponding slots (not shown) in the anvil (notshown). As with the above-described embodiments, the fins 5392 and thefoot portion 5384 serve to retain the anvil (not shown) in a desiredspaced closed position as the sled assembly 5380 is driven distallythrough the tissue clamped within the surgical end effector 5312. Theupstanding support portion 5386 is configured for attachment to a knifebar 2200 (FIG. 32). The sled assembly 5380 further has ahorizontally-extending actuator plate 5394 that is shaped for actuatingengagement with each of the actuation rods 5368 on the pushers 5360.

Operation of the surgical end effector 5312 will now be explained withreference to FIGS. 111 and 112. As the sled assembly 5380 is driven inthe distal direction “DD” through the staple cartridge 5330, theactuator plate 5394 sequentially contacts the actuation rods 5368 on thepushers 5360. As the sled assembly 5380 continues to move distally, theactuator plate 5394 sequentially contacts the actuator rods 5368 of thedrivers 5360 on each side of the elongated slot 5334. Such action causesthe drivers 5360 to rotate from a first unactuated position to anactuated portion wherein the pushers 5350 are driven towards the closedanvil. As the pushers 5350 are driven toward the anvil, the surgicalstaples 5352 thereon are driven into forming contact with the undersideof the anvil. Once the robotic system 1000 determines that the sledassembly 5080 has reached its distal most position through sensors orother means, the control system of the robotic system 1000 may thenretract the knife bar and sled assembly 5380 back to the startingposition. Thereafter, the robotic control system may then activate theprocedure for returning the anvil to the open position to release thestapled tissue.

FIGS. 117-121 depict one form of an automated reloading systemembodiment of the present invention, generally designated as 5500. Inone form, the automated reloading system 5500 is configured to replace a“spent” surgical end effector component in a manipulatable surgical toolportion of a robotic surgical system with a “new” surgical end effectorcomponent. As used herein, the term “surgical end effector component”may comprise, for example, a surgical staple cartridge, a disposableloading unit or other end effector components that, when used, are spentand must be replaced with a new component. Furthermore, the term “spent”means that the end effector component has been activated and is nolonger useable for its intended purpose in its present state. Forexample, in the context of a surgical staple cartridge or disposableloading unit, the term “spent” means that at least some of the unformedstaples that were previously supported therein have been “fired”therefrom. As used herein, the term “new” surgical end effectorcomponent refers to an end effector component that is in condition forits intended use. In the context of a surgical staple cartridge ordisposable loading unit, for example, the term “new” refers to such acomponent that has unformed staples therein and which is otherwise readyfor use.

In various embodiments, the automated reloading system 5500 includes abase portion 5502 that may be strategically located within a workenvelope 1109 of a robotic arm cart 1100 (FIG. 18) of a robotic system1000. As used herein, the term “manipulatable surgical tool portion”collectively refers to a surgical tool of the various types disclosedherein and other forms of surgical robotically-actuated tools that areoperably attached to, for example, a robotic arm cart 1100 or similardevice that is configured to automatically manipulate and actuate thesurgical tool. The term “work envelope” as used herein refers to therange of movement of the manipulatable surgical tool portion of therobotic system. FIG. 18 generally depicts an area that may comprise awork envelope of the robotic arm cart 1100. Those of ordinary skill inthe art will understand that the shape and size of the work envelopedepicted therein is merely illustrative. The ultimate size, shape andlocation of a work envelope will ultimately depend upon theconstruction, range of travel limitations, and location of themanipulatable surgical tool portion. Thus, the term “work envelope” asused herein is intended to cover a variety of different sizes and shapesof work envelopes and should not be limited to the specific size andshape of the sample work envelope depicted in FIG. 18.

As can be seen in FIG. 117, the base portion 5502 includes a newcomponent support section or arrangement 5510 that is configured tooperably support at least one new surgical end effector component in a“loading orientation”. As used herein, the term “loading orientation”means that the new end effector component is supported in such away soas to permit the corresponding component support portion of themanipulatable surgical tool portion to be brought into loadingengagement with (i.e., operably seated or operably attached to) the newend effector component (or the new end effector component to be broughtinto loading engagement with the corresponding component support portionof the manipulatable surgical tool portion) without human interventionbeyond that which may be necessary to actuate the robotic system. Aswill be further appreciated as the present Detailed Descriptionproceeds, in at least one embodiment, the preparation nurse will loadthe new component support section before the surgery with theappropriate length and color cartridges (some surgical staple cartridgesmay support certain sizes of staples the size of which may be indicatedby the color of the cartridge body) required for completing the surgicalprocedure. However, no direct human interaction is necessary during thesurgery to reload the robotic endocutter. In one form, the surgical endeffector component comprises a staple cartridge 2034 that is configuredto be operably seated within a component support portion (elongatedchannel) of any of the various other end effector arrangements describedabove. For explanation purposes, new (unused) cartridges will bedesignated as “2034 a” and spent cartridges will be designated as “2034b”. The Figures depict cartridges 2034 a, 2034 b designed for use with asurgical end effector 2012 that includes a channel 2022 and an anvil2024, the construction and operation of which were discussed in detailabove. Cartridges 2034 a, 2034 b are identical to cartridges 2034described above. In various embodiments, the cartridges 2034 a, 2034 bare configured to be snappingly retained (i.e., loading engagement)within the channel 2022 of a surgical end effector 2012. As the presentDetailed Description proceeds, however, those of ordinary skill in theart will appreciate that the unique and novel features of the automatedcartridge reloading system 5500 may be effectively employed inconnection with the automated removal and installation of othercartridge arrangements without departing from the spirit and scope ofthe present invention.

In the depicted embodiment, the term “loading orientation” means thatthe distal tip portion 2035 a of the a new surgical staple cartridge2034 a is inserted into a corresponding support cavity 5512 in the newcartridge support section 5510 such that the proximal end portion 2037 aof the new surgical staple cartridge 2034 a is located in a convenientorientation for enabling the arm cart 1100 to manipulate the surgicalend effector 2012 into a position wherein the new cartridge 2034 a maybe automatically loaded into the channel 2022 of the surgical endeffector 2012. In various embodiments, the base 5502 includes at leastone sensor 5504 which communicates with the control system 1003 of therobotic controller 1001 to provide the control system 1003 with thelocation of the base 5502 and/or the reload length and color doe eachstaged or new cartridge 2034 a.

As can also be seen in the Figures, the base 5502 further includes acollection receptacle 5520 that is configured to collect spentcartridges 2034 b that have been removed or disengaged from the surgicalend effector 2012 that is operably attached to the robotic system 1000.In addition, in one form, the automated reloading system 5500 includesan extraction system 5530 for automatically removing the spent endeffector component from the corresponding support portion of the endeffector or manipulatable surgical tool portion without specific humanintervention beyond that which may be necessary to activate the roboticsystem. In various embodiments, the extraction system 5530 includes anextraction hook member 5532. In one form, for example, the extractionhook member 5532 is rigidly supported on the base portion 5502. In oneembodiment, the extraction hook member has at least one hook 5534 formedthereon that is configured to hookingly engage the distal end 2035 of aspent cartridge 2034 b when it is supported in the elongated channel2022 of the surgical end effector 2012. In various forms, the extractionhook member 5532 is conveniently located within a portion of thecollection receptacle 5520 such that when the spent end effectorcomponent (cartridge 2034 b) is brought into extractive engagement withthe extraction hook member 5532, the spent end effector component(cartridge 2034 b) is dislodged from the corresponding component supportportion (elongated channel 2022), and falls into the collectionreceptacle 5020. Thus, to use this embodiment, the manipulatablesurgical tool portion manipulates the end effector attached thereto tobring the distal end 2035 of the spent cartridge 2034 b therein intohooking engagement with the hook 5534 and then moves the end effector insuch a way to dislodge the spent cartridge 2034 b from the elongatedchannel 2022.

In other arrangements, the extraction hook member 5532 comprises arotatable wheel configuration that has a pair of diametrically-opposedhooks 5334 protruding therefrom. See FIGS. 122 and 125. The extractionhook member 5532 is rotatably supported within the collection receptacle5520 and is coupled to an extraction motor 5540 that is controlled bythe controller 1001 of the robotic system. This form of the automatedreloading system 5500 may be used as follows. FIG. 119 illustrates theintroduction of the surgical end effector 2012 that is operably attachedto the manipulatable surgical tool portion 1200. As can be seen in thatFigure, the arm cart 1100 of the robotic system 1000 locates thesurgical end effector 2012 in the shown position wherein the hook end5534 of the extraction member 5532 hookingly engages the distal end 2035of the spent cartridge 2034 b in the surgical end effector 2012. Theanvil 2024 of the surgical end effector 2012 is in the open position.After the distal end 2035 of the spent cartridge 2034 b is engaged withthe hook end 5532, the extraction motor 5540 is actuated to rotate theextraction wheel 5532 to disengage the spent cartridge 2034 b from thechannel 2022. To assist with the disengagement of the spent cartridge2034 b from the channel 2022 (or if the extraction member 5530 isstationary), the robotic system 1000 may move the surgical end effector2012 in an upward direction (arrow “U” in FIG. 120). As the spentcartridge 2034 b is dislodged from the channel 2022, the spent cartridge2034 b falls into the collection receptacle 5520. Once the spentcartridge 2034 b has been removed from the surgical end effector 2012,the robotic system 1000 moves the surgical end effector 2012 to theposition shown in FIG. 121.

In various embodiments, a sensor arrangement 5533 is located adjacent tothe extraction member 5532 that is in communication with the controller1001 of the robotic system 1000. The sensor arrangement 5533 maycomprise a sensor that is configured to sense the presence of thesurgical end effector 2012 and, more particularly the tip 2035 b of thespent surgical staple cartridge 2034 b thereof as the distal tip portion2035 b is brought into engagement with the extraction member 5532. Insome embodiments, the sensor arrangement 5533 may comprise, for example,a light curtain arrangement. However, other forms of proximity sensorsmay be employed. In such arrangement, when the surgical end effector2012 with the spent surgical staple cartridge 2034 b is brought intoextractive engagement with the extraction member 5532, the sensor sensesthe distal tip 2035 b of the surgical staple cartridge 2034 b (e.g., thelight curtain is broken). When the extraction member 5532 spins and popsthe surgical staple cartridge 2034 b loose and it falls into thecollection receptacle 5520, the light curtain is again unbroken. Becausethe surgical end effector 2012 was not moved during this procedure, therobotic controller 1001 is assured that the spent surgical staplecartridge 2034 b has been removed therefrom. Other sensor arrangementsmay also be successfully employed to provide the robotic controller 1001with an indication that the spent surgical staple cartridge 2034 b hasbeen removed from the surgical end effector 2012.

As can be seen in FIG. 121, the surgical end effector 2012 is positionedto grasp a new surgical staple cartridge 2034 a between the channel 2022and the anvil 2024. More specifically, as shown in FIGS. 118 and 121,each cavity 5512 has a corresponding upstanding pressure pad 5514associated with it. The surgical end effector 2012 is located such thatthe pressure pad 5514 is located between the new cartridge 2034 a andthe anvil 2024. Once in that position, the robotic system 1000 closesthe anvil 2024 onto the pressure pad 5514 which serves to push the newcartridge 2034 a into snapping engagement with the channel 2022 of thesurgical end effector 2012. Once the new cartridge 2034 a has beensnapped into position within the elongated channel 2022, the roboticsystem 1000 then withdraws the surgical end effector 2012 from theautomated cartridge reloading system 5500 for use in connection withperforming another surgical procedure.

FIGS. 122-126 depict another automated reloading system 5600 that may beused to remove a spent disposable loading unit 3612 from a manipulatablesurgical tool arrangement 3600 (FIGS. 69-82) that is operably attachedto an arm cart 1100 or other portion of a robotic system 1000 and reloada new disposable loading unit 3612 therein. As can be seen in FIGS. 122and 123, one form of the automated reloading system 5600 includes ahousing 5610 that has a movable support assembly in the form of a rotarycarrousel top plate 5620 supported thereon which cooperates with thehousing 5610 to form a hollow enclosed area 5612. The automatedreloading system 5600 is configured to be operably supported within thework envelop of the manipulatable surgical tool portion of a roboticsystem as was described above. In various embodiments, the rotarycarrousel plate 5620 has a plurality of holes 5622 for supporting aplurality of orientation tubes 5660 therein. As can be seen in FIGS. 123and 124, the rotary carrousel plate 5620 is affixed to a spindle shaft5624. The spindle shaft 5624 is centrally disposed within the enclosedarea 5612 and has a spindle gear 5626 attached thereto. The spindle gear5626 is in meshing engagement with a carrousel drive gear 5628 that iscoupled to a carrousel drive motor 5630 that is in operativecommunication with the robotic controller 1001 of the robotic system1000.

Various embodiments of the automated reloading system 5600 may alsoinclude a carrousel locking assembly, generally designated as 5640. Invarious forms, the carrousel locking assembly 5640 includes a cam disc5642 that is affixed to the spindle shaft 5624. The spindle gear 5626may be attached to the underside of the cam disc 5642 and the cam disc5642 may be keyed onto the spindle shaft 5624. In alternativearrangements, the spindle gear 5626 and the cam disc 5642 may beindependently non-rotatably affixed to the spindle shaft 5624. As can beseen in FIGS. 123 and 124, a plurality of notches 5644 are spaced aroundthe perimeter of the cam disc 5642. A locking arm 5648 is pivotallymounted within the housing 5610 and is biased into engagement with theperimeter of the cam disc 5642 by a locking spring 5649. As can be seenin FIG. 122, the outer perimeter of the cam disc 5642 is rounded tofacilitate rotation of the cam disc 5642 relative to the locking arm5648. The edges of each notch 5644 are also rounded such that when thecam disc 5642 is rotated, the locking arm 5648 is cammed out ofengagement with the notches 5644 by the perimeter of the cam disc 5642.

Various forms of the automated reloading system 5600 are configured tosupport a portable/replaceable tray assembly 5650 that is configured tosupport a plurality of disposable loading units 3612 in individualorientation tubes 5660. More specifically and with reference to FIGS.123 and 124, the replaceable tray assembly 5650 comprises a tray 5652that has a centrally-disposed locator spindle 5654 protruding from theunderside thereof. The locator spindle 5654 is sized to be receivedwithin a hollow end 5625 of spindle shaft 5624. The tray 5652 has aplurality of holes 5656 therein that are configured to support anorientation tube 5660 therein. Each orientation tube 5660 is orientedwithin a corresponding hole 5656 in the replaceable tray assembly 5650in a desired orientation by a locating fin 5666 on the orientation tube5660 that is designed to be received within a corresponding locatingslot 5658 in the tray assembly 5650. In at least one embodiment, thelocating fin 5666 has a substantially V-shaped cross-sectional shapethat is sized to fit within a V-shaped locating slot 5658. Sucharrangement serves to orient the orientation tube 5660 in a desiredstarting position while enabling it to rotate within the hole 5656 whena rotary motion is applied thereto. That is, when a rotary motion isapplied to the orientation tube 5660 the V-shaped locating fin 5666 willpop out of its corresponding locating slot enabling the tube 5660 torotate relative to the tray 5652 as will be discussed in further detailbelow. As can also be seen in FIGS. 122-124, the replaceable tray 5652may be provided with one or more handle portions 5653 to facilitatetransport of the tray assembly 5652 when loaded with orientation tubes5660.

As can be seen in FIG. 126, each orientation tube 5660 comprises a bodyportion 5662 that has a flanged open end 5664. The body portion 5662defines a cavity 5668 that is sized to receive a portion of a disposableloading unit 3612 therein. To properly orient the disposable loadingunit 3612 within the orientation tube 5660, the cavity 5668 has a flatlocating surface 5670 formed therein. As can be seen in FIG. 126, theflat locating surface 5670 is configured to facilitate the insertion ofthe disposable loading unit into the cavity 5668 in a desired orpredetermined non-rotatable orientation. In addition, the end 5669 ofthe cavity 5668 may include a foam or cushion material 5672 that isdesigned to cushion the distal end of the disposable loading unit 3612within the cavity 5668. Also, the length of the locating surface maycooperate with a sliding support member 3689 of the axial drive assembly3680 of the disposable loading unit 3612 to further locate thedisposable loading unit 3612 at a desired position within theorientation tube 5660.

The orientation tubes 5660 may be fabricated from Nylon, polycarbonate,polyethylene, liquid crystal polymer, 6061 or 7075 aluminum, titanium,300 or 400 series stainless steel, coated or painted steel, platedsteel, etc. and, when loaded in the replaceable tray 5662 and thelocator spindle 5654 is inserted into the hollow end 5625 of spindleshaft 5624, the orientation tubes 5660 extend through correspondingholes 5662 in the carrousel top plate 5620. Each replaceable tray 5662is equipped with a location sensor 5663 that communicates with thecontrol system 1003 of the controller 1001 of the robotic system 1000.The sensor 5663 serves to identify the location of the reload system,and the number, length, color and fired status of each reload housed inthe tray. In addition, an optical sensor or sensors 5665 thatcommunicate with the robotic controller 1001 may be employed to sensethe type/size/length of disposable loading units that are loaded withinthe tray 5662.

Various embodiments of the automated reloading system 5600 furtherinclude a drive assembly 5680 for applying a rotary motion to theorientation tube 5660 holding the disposable loading unit 3612 to beattached to the shaft 3700 of the surgical tool 3600 (collectively the“manipulatable surgical tool portion”) that is operably coupled to therobotic system. The drive assembly 5680 includes a support yoke 5682that is attached to the locking arm 5648. Thus, the support yoke 5682pivots with the locking arm 5648. The support yoke 5682 rotatablysupports a tube idler wheel 5684 and a tube drive wheel 5686 that isdriven by a tube motor 5688 attached thereto. Tube motor 5688communicates with the control system 1003 and is controlled thereby. Thetube idler wheel 5684 and tube drive wheel 5686 are fabricated from, forexample, natural rubber, sanoprene, isoplast, etc. such that the outersurfaces thereof create sufficient amount of friction to result in therotation of an orientation tube 5660 in contact therewith uponactivation of the tube motor 5688. The idler wheel 5684 and tube drivewheel 5686 are oriented relative to each other to create a cradle area5687 therebetween for receiving an orientation tube 5060 in drivingengagement therein.

In use, one or more of the orientation tubes 5660 loaded in theautomated reloading system 5600 are left empty, while the otherorientation tubes 5660 may operably support a corresponding newdisposable loading unit 3612 therein. As will be discussed in furtherdetail below, the empty orientation tubes 5660 are employed to receive aspent disposable loading unit 3612 therein.

The automated reloading system 5600 may be employed as follows after thesystem 5600 is located within the work envelope of the manipulatablesurgical tool portion of a robotic system. If the manipulatable surgicaltool portion has a spent disposable loading unit 3612 operably coupledthereto, one of the orientation tubes 5660 that are supported on thereplaceable tray 5662 is left empty to receive the spent disposableloading unit 3612 therein. If, however, the manipulatable surgical toolportion does not have a disposable loading unit 3612 operably coupledthereto, each of the orientation tubes 5660 may be provided with aproperly oriented new disposable loading unit 3612.

As described hereinabove, the disposable loading unit 3612 employs arotary “bayonet-type” coupling arrangement for operably coupling thedisposable loading unit 3612 to a corresponding portion of themanipulatable surgical tool portion. That is, to attach a disposableloading unit 3612 to the corresponding portion of the manipulatablesurgical tool portion (3700—see FIG. 75, 76), a rotary installationmotion must be applied to the disposable loading unit 3612 and/or thecorresponding portion of the manipulatable surgical tool portion whenthose components have been moved into loading engagement with eachother. Such installation motions are collectively referred to herein as“loading motions”. Likewise, to decouple a spent disposable loading unit3612 from the corresponding portion of the manipulatable surgical tool,a rotary decoupling motion must be applied to the spent disposableloading unit 3612 and/or the corresponding portion of the manipulatablesurgical tool portion while simultaneously moving the spent disposableloading unit and the corresponding portion of the manipulatable surgicaltool away from each other. Such decoupling motions are collectivelyreferred to herein as “extraction motions”.

To commence the loading process, the robotic system 1000 is activated tomanipulate the manipulatable surgical tool portion and/or the automatedreloading system 5600 to bring the manipulatable surgical tool portioninto loading engagement with the new disposable loading unit 3612 thatis supported in the orientation tube 5660 that is in driving engagementwith the drive assembly 5680. Once the robotic controller 1001 (FIG. 17)of the robotic control system 1000 has located the manipulatablesurgical tool portion in loading engagement with the new disposableloading unit 3612, the robotic controller 1001 activates the driveassembly 5680 to apply a rotary loading motion to the orientation tube5660 in which the new disposable loading unit 3612 is supported and/orapplies another rotary loading motion to the corresponding portion ofthe manipulatable surgical tool portion. Upon application of such rotaryloading motions(s), the robotic controller 1001 also causes thecorresponding portion of the manipulatable surgical tool portion to bemoved towards the new disposable loading unit 3612 into loadingengagement therewith. Once the disposable loading unit 3612 is inloading engagement with the corresponding portion of the manipulatabletool portion, the loading motions are discontinued and the manipulatablesurgical tool portion may be moved away from the automated reloadingsystem 5600 carrying with it the new disposable loading unit 3612 thathas been operably coupled thereto.

To decouple a spent disposable loading unit 3612 from a correspondingmanipulatable surgical tool portion, the robotic controller 1001 of therobotic system manipulates the manipulatable surgical tool portion so asto insert the distal end of the spent disposable loading unit 3612 intothe empty orientation tube 5660 that remains in driving engagement withthe drive assembly 5680. Thereafter, the robotic controller 1001activates the drive assembly 5680 to apply a rotary extraction motion tothe orientation tube 5660 in which the spent disposable loading unit3612 is supported and/or applies a rotary extraction motion to thecorresponding portion of the manipulatable surgical tool portion. Therobotic controller 1001 also causes the manipulatable surgical toolportion to withdraw away from the spent rotary disposable loading unit3612. Thereafter the rotary extraction motion(s) are discontinued.

After the spent disposable loading unit 3612 has been removed from themanipulatable surgical tool portion, the robotic controller 1001 mayactivate the carrousel drive motor 5630 to index the carrousel top plate5620 to bring another orientation tube 5660 that supports a newdisposable loading unit 3612 therein into driving engagement with thedrive assembly 5680. Thereafter, the loading process may be repeated toattach the new disposable loading unit 3612 therein to the portion ofthe manipulatable surgical tool portion. The robotic controller 1001 mayrecord the number of disposable loading units that have been used from aparticular replaceable tray 5652. Once the controller 1001 determinesthat all of the new disposable loading units 3612 have been used fromthat tray, the controller 1001 may provide the surgeon with a signal(visual and/or audible) indicating that the tray 5652 supporting all ofthe spent disposable loading units 3612 must be replaced with a new tray5652 containing new disposable loading units 3612.

FIGS. 127-132 depict another non-limiting embodiment of a surgical tool6000 of the present invention that is well-adapted for use with arobotic system 1000 that has a tool drive assembly 1010 (FIG. 22) thatis operatively coupled to a master controller 1001 that is operable byinputs from an operator (i.e., a surgeon). As can be seen in FIG. 127,the surgical tool 6000 includes a surgical end effector 6012 thatcomprises an endocutter. In at least one form, the surgical tool 6000generally includes an elongated shaft assembly 6008 that has a proximalclosure tube 6040 and a distal closure tube 6042 that are coupledtogether by an articulation joint 6100. The surgical tool 6000 isoperably coupled to the manipulator by a tool mounting portion,generally designated as 6200. The surgical tool 6000 further includes aninterface 6030 which may mechanically and electrically couple the toolmounting portion 6200 to the manipulator in the various mannersdescribed in detail above.

In at least one embodiment, the surgical tool 6000 includes a surgicalend effector 6012 that comprises, among other things, at least onecomponent 6024 that is selectively movable between first and secondpositions relative to at least one other component 6022 in response tovarious control motions applied to component 6024 as will be discussedin further detail below to perform a surgical procedure. In variousembodiments, component 6022 comprises an elongated channel 6022configured to operably support a surgical staple cartridge 6034 thereinand component 6024 comprises a pivotally translatable clamping member,such as an anvil 6024. Various embodiments of the surgical end effector6012 are configured to maintain the anvil 6024 and elongated channel6022 at a spacing that assures effective stapling and severing of tissueclamped in the surgical end effector 6012. Unless otherwise stated, theend effector 6012 is similar to the surgical end effector 2012 describedabove and includes a cutting instrument (not shown) and a sled (notshown). The anvil 6024 may include a tab 6027 at its proximal end thatinteracts with a component of the mechanical closure system (describedfurther below) to facilitate the opening of the anvil 6024. Theelongated channel 6022 and the anvil 6024 may be made of an electricallyconductive material (such as metal) so that they may serve as part of anantenna that communicates with sensor(s) in the end effector, asdescribed above. The surgical staple cartridge 6034 could be made of anonconductive material (such as plastic) and the sensor may be connectedto or disposed in the surgical staple cartridge 6034, as was alsodescribed above.

As can be seen in FIG. 127, the surgical end effector 6012 is attachedto the tool mounting portion 6200 by the elongated shaft assembly 6008according to various embodiments. As shown in the illustratedembodiment, the elongated shaft assembly 6008 includes an articulationjoint generally designated as 6100 that enables the surgical endeffector 6012 to be selectively articulated about a first toolarticulation axis AA1-AA1 that is substantially transverse to alongitudinal tool axis LT-LT and a second tool articulation axis AA2-AA2that is substantially transverse to the longitudinal tool axis LT-LT aswell as the first articulation axis AA1-AA1. See FIG. 128. In variousembodiments, the elongated shaft assembly 6008 includes a closure tubeassembly 6009 that comprises a proximal closure tube 6040 and a distalclosure tube 6042 that are pivotably linked by a pivot links 6044 and6046. The closure tube assembly 6009 is movably supported on a spineassembly generally designated as 6102.

As can be seen in FIG. 129, the proximal closure tube 6040 is pivotallylinked to an intermediate closure tube joint 6043 by an upper pivot link6044U and a lower pivot link 6044L such that the intermediate closuretube joint 6043 is pivotable relative to the proximal closure tube 6040about a first closure axis CA1-CA1 and a second closure axis CA2-CA2. Invarious embodiments, the first closure axis CA1-CA1 is substantiallyparallel to the second closure axis CA2-CA2 and both closure axesCA1-CA1, CA2-CA2 are substantially transverse to the longitudinal toolaxis LT-LT. As can be further seen in FIG. 129, the intermediate closuretube joint 6043 is pivotally linked to the distal closure tube 6042 by aleft pivot link 6046L and a right pivot link 6046R such that theintermediate closure tube joint 6043 is pivotable relative to the distalclosure tube 6042 about a third closure axis CA3-CA3 and a fourthclosure axis CA4-CA4. In various embodiments, the third closure axisCA3-CA3 is substantially parallel to the fourth closure axis CA4-CA4 andboth closure axes CA3-CA3, CA4-CA4 are substantially transverse to thefirst and second closure axes CA1-CA1, CA2-CA2 as well as tolongitudinal tool axis LT-LT.

The closure tube assembly 6009 is configured to axially slide on thespine assembly 6102 in response to actuation motions applied thereto.The distal closure tube 6042 includes an opening 6045 which interfaceswith the tab 6027 on the anvil 6024 to facilitate opening of the anvil6024 as the distal closure tube 6042 is moved axially in the proximaldirection “PD”. The closure tubes 6040, 6042 may be made of electricallyconductive material (such as metal) so that they may serve as part ofthe antenna, as described above. Components of the spine assembly 6102may be made of a nonconductive material (such as plastic).

As indicated above, the surgical tool 6000 includes a tool mountingportion 6200 that is configured for operable attachment to the toolmounting assembly 1010 of the robotic system 1000 in the various mannersdescribed in detail above. As can be seen in FIG. 131, the tool mountingportion 6200 comprises a tool mounting plate 6202 that operably supportsa transmission arrangement 6204 thereon. In various embodiments, thetransmission arrangement 6204 includes an articulation transmission 6142that comprises a portion of an articulation system 6140 for articulatingthe surgical end effector 6012 about a first tool articulation axisTA1-TA1 and a second tool articulation axis TA2-TA2. The first toolarticulation axis TA1-TA1 is substantially transverse to the second toolarticulation axis TA2-TA2 and both of the first and second toolarticulation axes are substantially transverse to the longitudinal toolaxis LT-LT. See FIG. 128.

To facilitate selective articulation of the surgical end effector 6012about the first and second tool articulation axes TA1-TA1, TA2-TA2, thespine assembly 6102 comprises a proximal spine portion 6110 that ispivotally coupled to a distal spine portion 6120 by pivot pins 6122 forselective pivotal travel about TA1-TA1. Similarly, the distal spineportion 6120 is pivotally attached to the elongated channel 6022 of thesurgical end effector 6012 by pivot pins 6124 to enable the surgical endeffector 6012 to selectively pivot about the second tool axis TA2-TA2relative to the distal spine portion 6120.

In various embodiments, the articulation system 6140 further includes aplurality of articulation elements that operably interface with thesurgical end effector 6012 and an articulation control arrangement 6160that is operably supported in the tool mounting member 6200 as willdescribed in further detail below. In at least one embodiment, thearticulation elements comprise a first pair of first articulation cables6144 and 6146. The first articulation cables are located on a first orright side of the longitudinal tool axis. Thus, the first articulationcables are referred to herein as a right upper cable 6144 and a rightlower cable 6146. The right upper cable 6144 and the right lower cable6146 extend through corresponding passages 6147, 6148, respectivelyalong the right side of the proximal spine portion 6110. See FIG. 132.The articulation system 6140 further includes a second pair of secondarticulation cables 6150, 6152. The second articulation cables arelocated on a second or left side of the longitudinal tool axis. Thus,the second articulation cables are referred to herein as a left upperarticulation cable 6150 and a left articulation cable 6152. The leftupper articulation cable 6150 and the left lower articulation cable 6152extend through passages 6153, 6154, respectively in the proximal spineportion 6110.

As can be seen in FIG. 128, the right upper cable 6144 extends around anupper pivot joint 6123 and is attached to a left upper side of theelongated channel 6022 at a left pivot joint 6125. The right lower cable6146 extends around a lower pivot joint 6126 and is attached to a leftlower side of the elongated channel 6022 at left pivot joint 6125. Theleft upper cable 6150 extends around the upper pivot joint 6123 and isattached to a right upper side of the elongated channel 6022 at a rightpivot joint 6127. The left lower cable 6152 extends around the lowerpivot joint 6126 and is attached to a right lower side of the elongatedchannel 6022 at right pivot joint 6127. Thus, to pivot the surgical endeffector 6012 about the first tool articulation axis TA1-TA1 to the left(arrow “L”), the right upper cable 6144 and the right lower cable 6146must be pulled in the proximal direction “PD”. To articulate thesurgical end effector 6012 to the right (arrow “R”) about the first toolarticulation axis TA1-TA1, the left upper cable 6150 and the left lowercable 6152 must be pulled in the proximal direction “PD”. To articulatethe surgical end effector 6012 about the second tool articulation axisTA2-TA2, in an upward direction (arrow “U”), the right upper cable 6144and the left upper cable 6150 must be pulled in the proximal direction“PD”. To articulate the surgical end effector 6012 in the downwarddirection (arrow “DW”) about the second tool articulation axis TA2-TA2,the right lower cable 6146 and the left lower cable 6152 must be pulledin the proximal direction “PD”.

The proximal ends of the articulation cables 6144, 6146, 6150, 6152 arecoupled to the articulation control arrangement 6160 which comprises aball joint assembly that is a part of the articulation transmission6142. More specifically and with reference to FIG. 132, the ball jointassembly 6160 includes a ball-shaped member 6162 that is formed on aproximal portion of the proximal spine 6110. Movably supported on theball-shaped member 6162 is an articulation control ring 6164. As can befurther seen in FIG. 132, the proximal ends of the articulation cables6144, 6146, 6150, 6152 are coupled to the articulation control ring 6164by corresponding ball joint arrangements 6166. The articulation controlring 6164 is controlled by an articulation drive assembly 6170. As canbe most particularly seen in FIG. 132, the proximal ends of the firstarticulation cables 6144, 6146 are attached to the articulation controlring 6164 at corresponding spaced first points 6149, 6151 that arelocated on plane 6159. Likewise, the proximal ends of the secondarticulation cables 6150, 6152 are attached to the articulation controlring 6164 at corresponding spaced second points 6153, 6155 that are alsolocated along plane 6159. As the present Detailed Description proceeds,those of ordinary skill in the art will appreciate that such cableattachment configuration on the articulation control ring 6164facilitates the desired range of articulation motions as thearticulation control ring 6164 is manipulated by the articulation driveassembly 6170.

In various forms, the articulation drive assembly 6170 comprises ahorizontal articulation assembly generally designated as 6171. In atleast one form, the horizontal articulation assembly 6171 comprises ahorizontal push cable 6172 that is attached to a horizontal geararrangement 6180. The articulation drive assembly 6170 further comprisesa vertically articulation assembly generally designated as 6173. In atleast one form, the vertical articulation assembly 6173 comprises avertical push cable 6174 that is attached to a vertical gear arrangement6190. As can be seen in FIGS. 131 and 132, the horizontal push cable6172 extends through a support plate 6167 that is attached to theproximal spine portion 6110. The distal end of the horizontal push cable6174 is attached to the articulation control ring 6164 by acorresponding ball/pivot joint 6168. The vertical push cable 6174extends through the support plate 6167 and the distal end thereof isattached to the articulation control ring 6164 by a correspondingball/pivot joint 6169.

The horizontal gear arrangement 6180 includes a horizontal driven gear6182 that is pivotally mounted on a horizontal shaft 6181 that isattached to a proximal portion of the proximal spine portion 6110. Theproximal end of the horizontal push cable 6172 is pivotally attached tothe horizontal driven gear 6182 such that, as the horizontal driven gear6172 is rotated about horizontal pivot axis HA, the horizontal pushcable 6172 applies a first pivot motion to the articulation control ring6164. Likewise, the vertical gear arrangement 6190 includes a verticaldriven gear 6192 that is pivotally supported on a vertical shaft 6191attached to the proximal portion of the proximal spine portion 6110 forpivotal travel about a vertical pivot axis VA. The proximal end of thevertical push cable 6174 is pivotally attached to the vertical drivengear 6192 such that as the vertical driven gear 6192 is rotated aboutvertical pivot axis VA, the vertical push cable 6174 applies a secondpivot motion to the articulation control ring 6164.

The horizontal driven gear 6182 and the vertical driven gear 6192 aredriven by an articulation gear train 6300 that operably interfaces withan articulation shifter assembly 6320. In at least one form, thearticulation shifter assembly comprises an articulation drive gear 6322that is coupled to a corresponding one of the driven discs or elements1304 on the adapter side 1307 of the tool mounting plate 6202. See FIG.26. Thus, application of a rotary input motion from the robotic system1000 through the tool drive assembly 1010 to the corresponding drivenelement 1304 will cause rotation of the articulation drive gear 6322when the interface 1230 is coupled to the tool holder 1270. Anarticulation driven gear 6324 is attached to a splined shifter shaft6330 that is rotatably supported on the tool mounting plate 6202. Thearticulation driven gear 6324 is in meshing engagement with thearticulation drive gear 6322 as shown. Thus, rotation of thearticulation drive gear 6322 will result in the rotation of the shaft6330. In various forms, a shifter driven gear assembly 6340 is movablysupported on the splined portion 6332 of the shifter shaft 6330.

In various embodiments, the shifter driven gear assembly 6340 includes adriven shifter gear 6342 that is attached to a shifter plate 6344. Theshifter plate 6344 operably interfaces with a shifter solenoid assembly6350. The shifter solenoid assembly 6350 is coupled to correspondingpins 6352 by conductors 6352. See FIG. 131. Pins 6352 are oriented toelectrically communicate with slots 1258 (FIG. 25) on the tool side 1244of the adaptor 1240. Such arrangement serves to electrically couple theshifter solenoid assembly 6350 to the robotic controller 1001. Thus,activation of the shifter solenoid 6350 will shift the shifter drivengear assembly 6340 on the splined portion 6332 of the shifter shaft 6330as represented by arrow “S” in FIGS. 131 and 132. Various embodiments ofthe articulation gear train 6300 further include a horizontal gearassembly 6360 that includes a first horizontal drive gear 6362 that ismounted on a shaft 6361 that is rotatably attached to the tool mountingplate 6202. The first horizontal drive gear 6362 is supported in meshingengagement with a second horizontal drive gear 6364. As can be seen inFIG. 137, the horizontal driven gear 6182 is in meshing engagement withthe distal face portion 6365 of the second horizontal driven gear 6364.

Various embodiments of the articulation gear train 6300 further includea vertical gear assembly 6370 that includes a first vertical drive gear6372 that is mounted on a shaft 6371 that is rotatably supported on thetool mounting plate 6202. The first vertical drive gear 6372 issupported in meshing engagement with a second vertical drive gear 6374that is concentrically supported with the second horizontal drive gear6364. The second vertical drive gear 6374 is rotatably supported on theproximal spine portion 6110 for travel therearound. The secondhorizontal drive gear 6364 is rotatably supported on a portion of saidsecond vertical drive gear 6374 for independent rotatable travelthereon. As can be seen in FIG. 132, the vertical driven gear 6192 is inmeshing engagement with the distal face portion 6375 of the secondvertical driven gear 6374.

In various forms, the first horizontal drive gear 6362 has a firstdiameter and the first vertical drive gear 6372 has a second diameter.As can be seen in FIGS. 131 and 132, the shaft 6361 is not on a commonaxis with shaft 6371. That is, the first horizontal driven gear 6362 andthe first vertical driven gear 6372 do not rotate about a common axis.Thus, when the shifter gear 6342 is positioned in a center “locking”position such that the shifter gear 6342 is in meshing engagement withboth the first horizontal driven gear 6362 and the first vertical drivegear 6372, the components of the articulation system 6140 are locked inposition. Thus, the shiftable shifter gear 6342 and the arrangement offirst horizontal and vertical drive gears 6362, 6372 as well as thearticulation shifter assembly 6320 collectively may be referred to as anarticulation locking system, generally designated as 6380.

In use, the robotic controller 1001 of the robotic system 1000 maycontrol the articulation system 6140 as follows. To articulate the endeffector 6012 to the left about the first tool articulation axisTA1-TA1, the robotic controller 1001 activates the shifter solenoidassembly 6350 to bring the shifter gear 6342 into meshing engagementwith the first horizontal drive gear 6362. Thereafter, the controller1001 causes a first rotary output motion to be applied to thearticulation drive gear 6322 to drive the shifter gear in a firstdirection to ultimately drive the horizontal driven gear 6182 in anotherfirst direction. The horizontal driven gear 6182 is driven to pivot thearticulation ring 6164 on the ball-shaped portion 6162 to thereby pullright upper cable 6144 and the right lower cable 6146 in the proximaldirection “PD”. To articulate the end effector 6012 to the right aboutthe first tool articulation axis TA1-TA1, the robotic controller 1001activates the shifter solenoid assembly 6350 to bring the shifter gear6342 into meshing engagement with the first horizontal drive gear 6362.Thereafter, the controller 1001 causes the first rotary output motion inan opposite direction to be applied to the articulation drive gear 6322to drive the shifter gear 6342 in a second direction to ultimately drivethe horizontal driven gear 6182 in another second direction. Suchactions result in the articulation control ring 6164 moving in such amanner as to pull the left upper cable 6150 and the left lower cable6152 in the proximal direction “PD”. In various embodiments the gearratios and frictional forces generated between the gears of the verticalgear assembly 6370 serve to prevent rotation of the vertical driven gear6192 as the horizontal gear assembly 6360 is actuated.

To articulate the end effector 6012 in the upper direction about thesecond tool articulation axis TA2-TA2, the robotic controller 1001activates the shifter solenoid assembly 6350 to bring the shifter gear6342 into meshing engagement with the first vertical drive gear 6372.Thereafter, the controller 1001 causes the first rotary output motion tobe applied to the articulation drive gear 6322 to drive the shifter gear6342 in a first direction to ultimately drive the vertical driven gear6192 in another first direction. The vertical driven gear 6192 is drivento pivot the articulation ring 6164 on the ball-shaped portion 6162 ofthe proximal spine portion 6110 to thereby pull right upper cable 6144and the left upper cable 6150 in the proximal direction “PD”. Toarticulate the end effector 6012 in the downward direction about thesecond tool articulation axis TA2-TA2, the robotic controller 1001activates the shifter solenoid assembly 6350 to bring the shifter gear6342 into meshing engagement with the first vertical drive gear 6372.Thereafter, the controller 1001 causes the first rotary output motion tobe applied in an opposite direction to the articulation drive gear 6322to drive the shifter gear 6342 in a second direction to ultimately drivethe vertical driven gear 6192 in another second direction. Such actionsthereby cause the articulation control ring 6164 to pull the right lowercable 6146 and the left lower cable 6152 in the proximal direction “PD”.In various embodiments, the gear ratios and frictional forces generatedbetween the gears of the horizontal gear assembly 6360 serve to preventrotation of the horizontal driven gear 6182 as the vertical gearassembly 6370 is actuated.

In various embodiments, a variety of sensors may communicate with therobotic controller 1001 to determine the articulated position of the endeffector 6012. Such sensors may interface with, for example, thearticulation joint 6100 or be located within the tool mounting portion6200. For example, sensors may be employed to detect the position of thearticulation control ring 6164 on the ball-shaped portion 6162 of theproximal spine portion 6110. Such feedback from the sensors to thecontroller 1001 permits the controller 1001 to adjust the amount ofrotation and the direction of the rotary output to the articulationdrive gear 6322. Further, as indicated above, when the shifter drivegear 6342 is centrally positioned in meshing engagement with the firsthorizontal drive gear 6362 and the first vertical drive gear 6372, theend effector 6012 is locked in the articulated position. Thus, after thedesired amount of articulation has been attained, the controller 1001may activate the shifter solenoid assembly 6350 to bring the shiftergear 6342 into meshing engagement with the first horizontal drive gear6362 and the first vertical drive gear 6372. In alternative embodiments,the shifter solenoid assembly 6350 may be spring activated to thecentral locked position.

In use, it may be desirable to rotate the surgical end effector 6012about the longitudinal tool axis LT-LT. In at least one embodiment, thetransmission arrangement 6204 on the tool mounting portion includes arotational transmission assembly 6400 that is configured to receive acorresponding rotary output motion from the tool drive assembly 1010 ofthe robotic system 1000 and convert that rotary output motion to arotary control motion for rotating the elongated shaft assembly 6008(and surgical end effector 6012) about the longitudinal tool axis LT-LT.In various embodiments, for example, a proximal end portion 6041 of theproximal closure tube 6040 is rotatably supported on the tool mountingplate 6202 of the tool mounting portion 6200 by a forward support cradle6205 and a closure sled 6510 that is also movably supported on the toolmounting plate 6202. In at least one form, the rotational transmissionassembly 6400 includes a tube gear segment 6402 that is formed on (orattached to) the proximal end 6041 of the proximal closure tube 6040 foroperable engagement by a rotational gear assembly 6410 that is operablysupported on the tool mounting plate 6202. As can be seen in FIG. 131,the rotational gear assembly 6410, in at least one embodiment, comprisesa rotation drive gear 6412 that is coupled to a corresponding second oneof the driven discs or elements 1304 on the adapter side 1307 of thetool mounting plate 6202 when the tool mounting portion 6200 is coupledto the tool drive assembly 1010. See FIG. 26. The rotational gearassembly 6410 further comprises a first rotary driven gear 6414 that isrotatably supported on the tool mounting plate 6202 in meshingengagement with the rotation drive gear 6412. The first rotary drivengear 6414 is attached to a drive shaft 6416 that is rotatably supportedon the tool mounting plate 6202. A second rotary driven gear 6418 isattached to the drive shaft 6416 and is in meshing engagement with tubegear segment 6402 on the proximal closure tube 6040. Application of asecond rotary output motion from the tool drive assembly 1010 of therobotic system 1000 to the corresponding driven element 1304 willthereby cause rotation of the rotation drive gear 6412. Rotation of therotation drive gear 6412 ultimately results in the rotation of theelongated shaft assembly 6008 (and the surgical end effector 6012) aboutthe longitudinal tool axis LT-LT. It will be appreciated that theapplication of a rotary output motion from the tool drive assembly 1010in one direction will result in the rotation of the elongated shaftassembly 6008 and surgical end effector 6012 about the longitudinal toolaxis LT-LT in a first direction and an application of the rotary outputmotion in an opposite direction will result in the rotation of theelongated shaft assembly 6008 and surgical end effector 6012 in a seconddirection that is opposite to the first direction.

In at least one embodiment, the closure of the anvil 2024 relative tothe staple cartridge 2034 is accomplished by axially moving a closureportion of the elongated shaft assembly 2008 in the distal direction“DD” on the spine assembly 2049. As indicated above, in variousembodiments, the proximal end portion 6041 of the proximal closure tube6040 is supported by the closure sled 6510 which comprises a portion ofa closure transmission, generally depicted as 6512. As can be seen inFIG. 131, the proximal end portion 6041 of the proximal closure tubeportion 6040 has a collar 6048 formed thereon. The closure sled 6510 iscoupled to the collar 6048 by a yoke 6514 that engages an annular groove6049 in the collar 6048. Such arrangement serves to enable the collar6048 to rotate about the longitudinal tool axis LT-LT while still beingcoupled to the closure transmission 6512. In various embodiments, theclosure sled 6510 has an upstanding portion 6516 that has a closure rackgear 6518 formed thereon. The closure rack gear 6518 is configured fordriving engagement with a closure gear assembly 6520. See FIG. 131.

In various forms, the closure gear assembly 6520 includes a closure spurgear 6522 that is coupled to a corresponding second one of the drivendiscs or elements 1304 on the adapter side 1307 of the tool mountingplate 6202. See FIG. 26. Thus, application of a third rotary outputmotion from the tool drive assembly 1010 of the robotic system 1000 tothe corresponding second driven element 1304 will cause rotation of theclosure spur gear 6522 when the tool mounting portion 6202 is coupled tothe tool drive assembly 1010. The closure gear assembly 6520 furtherincludes a closure reduction gear set 6524 that is supported in meshingengagement with the closure spur gear 6522 and the closure rack gear2106. Thus, application of a third rotary output motion from the tooldrive assembly 1010 of the robotic system 1000 to the correspondingsecond driven element 1304 will cause rotation of the closure spur gear6522 and the closure transmission 6512 and ultimately drive the closuresled 6510 and the proximal closure tube 6040 axially on the proximalspine portion 6110. The axial direction in which the proximal closuretube 6040 moves ultimately depends upon the direction in which the thirddriven element 1304 is rotated. For example, in response to one rotaryoutput motion received from the tool drive assembly 1010 of the roboticsystem 1000, the closure sled 6510 will be driven in the distaldirection “DD” and ultimately drive the proximal closure tube 6040 inthe distal direction “DD”. As the proximal closure tube 6040 is drivendistally, the distal closure tube 6042 is also driven distally by virtueof it connection with the proximal closure tube 6040. As the distalclosure tube 6042 is driven distally, the end of the closure tube 6042will engage a portion of the anvil 6024 and cause the anvil 6024 topivot to a closed position. Upon application of an “opening” out putmotion from the tool drive assembly 1010 of the robotic system 1000, theclosure sled 6510 and the proximal closure tube 6040 will be driven inthe proximal direction “PD” on the proximal spine portion 6110. As theproximal closure tube 6040 is driven in the proximal direction “PD”, thedistal closure tube 6042 will also be driven in the proximal direction“PD”. As the distal closure tube 6042 is driven in the proximaldirection “PD”, the opening 6045 therein interacts with the tab 6027 onthe anvil 6024 to facilitate the opening thereof. In variousembodiments, a spring (not shown) may be employed to bias the anvil 6024to the open position when the distal closure tube 6042 has been moved toits starting position. In various embodiments, the various gears of theclosure gear assembly 6520 are sized to generate the necessary closureforces needed to satisfactorily close the anvil 6024 onto the tissue tobe cut and stapled by the surgical end effector 6012. For example, thegears of the closure transmission 6520 may be sized to generateapproximately 70-120 pounds of closure forces.

In various embodiments, the cutting instrument is driven through thesurgical end effector 6012 by a knife bar 6530. See FIG. 131. In atleast one form, the knife bar 6530 is fabricated with a jointarrangement (not shown) and/or is fabricated from material that canaccommodate the articulation of the surgical end effector 6102 about thefirst and second tool articulation axes while remaining sufficientlyrigid so as to push the cutting instrument through tissue clamped in thesurgical end effector 6012. The knife bar 6530 extends through a hollowpassage 6532 in the proximal spine portion 6110.

In various embodiments, a proximal end 6534 of the knife bar 6530 isrotatably affixed to a knife rack gear 6540 such that the knife bar 6530is free to rotate relative to the knife rack gear 6540. The distal endof the knife bar 6530 is attached to the cutting instrument in thevarious manners described above. As can be seen in FIG. 131, the kniferack gear 6540 is slidably supported within a rack housing 6542 that isattached to the tool mounting plate 6202 such that the knife rack gear6540 is retained in meshing engagement with a knife drive transmissionportion 6550 of the transmission arrangement 6204. In variousembodiments, the knife drive transmission portion 6550 comprises a knifegear assembly 6560. More specifically and with reference to FIG. 131, inat least one embodiment, the knife gear assembly 6560 includes a knifespur gear 6562 that is coupled to a corresponding fourth one of thedriven discs or elements 1304 on the adapter side 1307 of the toolmounting plate 6202. See FIG. 26. Thus, application of another rotaryoutput motion from the robotic system 1000 through the tool driveassembly 1010 to the corresponding fourth driven element 1304 will causerotation of the knife spur gear 6562. The knife gear assembly 6560further includes a knife gear reduction set 6564 that includes a firstknife driven gear 6566 and a second knife drive gear 6568. The knifegear reduction set 6564 is rotatably mounted to the tool mounting plate6202 such that the first knife driven gear 6566 is in meshing engagementwith the knife spur gear 6562. Likewise, the second knife drive gear6568 is in meshing engagement with a third knife drive gear assembly6570. As shown in FIG. 131, the second knife driven gear 6568 is inmeshing engagement with a fourth knife driven gear 6572 of the thirdknife drive gear assembly 6570. The fourth knife driven gear 6572 is inmeshing engagement with a fifth knife driven gear assembly 6574 that isin meshing engagement with the knife rack gear 6540. In variousembodiments, the gears of the knife gear assembly 6560 are sized togenerate the forces needed to drive the cutting instrument through thetissue clamped in the surgical end effector 6012 and actuate the staplestherein. For example, the gears of the knife gear assembly 6560 may besized to generate approximately 40 to 100 pounds of driving force. Itwill be appreciated that the application of a rotary output motion fromthe tool drive assembly 1010 in one direction will result in the axialmovement of the cutting instrument in a distal direction and applicationof the rotary output motion in an opposite direction will result in theaxial travel of the cutting instrument in a proximal direction.

As can be appreciated from the foregoing description, the surgical tool6000 represents a vast improvement over prior robotic tool arrangements.The unique and novel transmission arrangement employed by the surgicaltool 6000 enables the tool to be operably coupled to a tool holderportion 1010 of a robotic system that only has four rotary outputbodies, yet obtain the rotary output motions therefrom to: (i)articulate the end effector about two different articulation axes thatare substantially transverse to each other as well as the longitudinaltool axis; (ii) rotate the end effector 6012 about the longitudinal toolaxis; (iii) close the anvil 6024 relative to the surgical staplecartridge 6034 to varying degrees to enable the end effector 6012 to beused to manipulate tissue and then clamp it into position for cuttingand stapling; and (iv) firing the cutting instrument to cut through thetissue clamped within the end effector 6012. The unique and novelshifter arrangements of various embodiments of the present inventiondescribed above enable two different articulation actions to be poweredfrom a single rotatable body portion of the robotic system.

The various embodiments of the present invention have been describedabove in connection with cutting-type surgical instruments. It should benoted, however, that in other embodiments, the inventive surgicalinstrument disclosed herein need not be a cutting-type surgicalinstrument, but rather could be used in any type of surgical instrumentincluding remote sensor transponders. For example, it could be anon-cutting endoscopic instrument, a grasper, a stapler, a clip applier,an access device, a drug/gene therapy delivery device, an energy deviceusing ultrasound, RF, laser, etc. In addition, the present invention maybe in laparoscopic instruments, for example. The present invention alsohas application in conventional endoscopic and open surgicalinstrumentation as well as robotic-assisted surgery.

FIG. 133 depicts use of various aspects of certain embodiments of thepresent invention in connection with a surgical tool 7000 that has anultrasonically powered end effector 7012. The end effector 7012 isoperably attached to a tool mounting portion 7100 by an elongated shaftassembly 7008. The tool mounting portion 7100 may be substantiallysimilar to the various tool mounting portions described hereinabove. Inone embodiment, the end effector 7012 includes an ultrasonically poweredjaw portion 7014 that is powered by alternating current or directcurrent in a known manner. Such ultrasonically-powered devices aredisclosed, for example, in U.S. Pat. No. 6,783,524, entitled ROBOTICSURGICAL TOOL WITH ULTRASOUND CAUTERIZING AND CUTTING INSTRUMENT, theentire disclosure of which is herein incorporated by reference. In theillustrated embodiment, a separate power cord 7020 is shown. It will beunderstood, however, that the power may be supplied thereto from therobotic controller 1001 through the tool mounting portion 7100. Thesurgical end effector 7012 further includes a movable jaw 7016 that maybe used to clamp tissue onto the ultrasonic jaw portion 7014. Themovable jaw portion 7016 may be selectively actuated by the roboticcontroller 1001 through the tool mounting portion 7100 in anyone of thevarious manners herein described.

FIG. 134 illustrates use of various aspects of certain embodiments ofthe present invention in connection with a surgical tool 8000 that hasan end effector 8012 that comprises a linear stapling device. The endeffector 8012 is operably attached to a tool mounting portion 8100 by anelongated shaft assembly 3700 of the type and construction describeabove. However, the end effector 8012 may be attached to the toolmounting portion 8100 by a variety of other elongated shaft assembliesdescribed herein. In one embodiment, the tool mounting portion 8100 maybe substantially similar to tool mounting portion 3750. However, variousother tool mounting portions and their respective transmissionarrangements describe in detail herein may also be employed. Such linearstapling head portions are also disclosed, for example, in U.S. Pat. No.7,673,781, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THATSUPPORTS MULTIPLE WIRE DIAMETER STAPLES, the entire disclosure of whichis herein incorporated by reference.

Various sensor embodiments described in U.S. Pat. No. 8,167,185 toShelton, I V et al., the disclosure of which is herein incorporated byreference in its entirety, may be employed with many of the surgicaltool embodiments disclosed herein. As was indicated above, the mastercontroller 1001 generally includes master controllers (generallyrepresented by 1003) which are grasped by the surgeon and manipulated inspace while the surgeon views the procedure via a stereo display 1002.See FIG. 17. The master controllers 1001 are manual input devices whichpreferably move with multiple degrees of freedom, and which oftenfurther have an actuatable handle for actuating the surgical tools. Someof the surgical tool embodiments disclosed herein employ a motor ormotors in their tool drive portion to supply various control motions tothe tool's end effector. Such embodiments may also obtain additionalcontrol motion(s) from the motor arrangement employed in the roboticsystem components. Other embodiments disclosed herein obtain all of thecontrol motions from motor arrangements within the robotic system.

Such motor powered arrangements may employ various sensor arrangementsthat are disclosed in the published US patent application cited above toprovide the surgeon with a variety of forms of feedback withoutdeparting from the spirit and scope of the present invention. Forexample, those master controller arrangements 1003 that employ amanually actuatable firing trigger can employ run motor sensor(s) toprovide the surgeon with feedback relating to the amount of forceapplied to or being experienced by the cutting member. The run motorsensor(s) may be configured for communication with the firing triggerportion to detect when the firing trigger portion has been actuated tocommence the cutting/stapling operation by the end effector. The runmotor sensor may be a proportional sensor such as, for example, arheostat or variable resistor. When the firing trigger is drawn in, thesensor detects the movement, and sends an electrical signal indicativeof the voltage (or power) to be supplied to the corresponding motor.When the sensor is a variable resistor or the like, the rotation of themotor may be generally proportional to the amount of movement of thefiring trigger. That is, if the operator only draws or closes the firingtrigger in a small amount, the rotation of the motor is relatively low.When the firing trigger is fully drawn in (or in the fully closedposition), the rotation of the motor is at its maximum. In other words,the harder the surgeon pulls on the firing trigger, the more voltage isapplied to the motor causing greater rates of rotation. Otherarrangements may provide the surgeon with a feed back meter 1005 thatmay be viewed through the display 1002 and provide the surgeon with avisual indication of the amount of force being applied to the cuttinginstrument or dynamic clamping member. Other sensor arrangements may beemployed to provide the master controller 1001 with an indication as towhether a staple cartridge has been loaded into the end effector,whether the anvil has been moved to a closed position prior to firing,etc.

In alternative embodiments, a motor-controlled interface may be employedin connection with the controller 1001 that limit the maximum triggerpull based on the amount of loading (e.g., clamping force, cuttingforce, etc.) experienced by the surgical end effector. For example, theharder it is to drive the cutting instrument through the tissue clampedwithin the end effector, the harder it would be to pull/actuate theactivation trigger. In still other embodiments, the trigger on thecontroller 1001 is arranged such that the trigger pull location isproportionate to the end effector-location/condition. For example, thetrigger is only fully depressed when the end effector is fully fired.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Although the present invention has been described herein in connectionwith certain disclosed embodiments, many modifications and variations tothose embodiments may be implemented. For example, different types ofend effectors may be employed. Also, where materials are disclosed forcertain components, other materials may be used. The foregoingdescription and following claims are intended to cover all suchmodification and variations.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A surgical system, comprising: a first rotaryoutput member; a second rotary output member; a third rotary outputmember; a surgical end effector, comprising: a first jaw and a secondjaw, wherein one of said first and second jaws is movable relative tothe other of said first and second jaws between open and closedpositions upon application of jaw control motions thereto and whereinone of said first and second jaws comprises a surgical staple cartridge;and a firing member axially movable between a starting position and anending position within said first and second jaws, said firing memberconfigured to axially pass through said first and second jaws to ejectsurgical staples housed within said surgical staple cartridge andwherein said surgical system further comprises: an elongate shaftassembly defining a longitudinal tool axis and operably coupled to saidsurgical end effector to facilitate selective articulation of saidsurgical end effector relative to said longitudinal tool axis, saidelongate shaft assembly comprising: a plurality of articulation membersmovably supported by said elongate shaft assembly and operablyinterfacing with said surgical end effector; and a firing shaft operablyinterfacing with said firing member to apply a firing motion thereto andwherein said surgical system further comprises: an articulationtransmission operably interfacing with said first rotary output memberand said plurality of articulation members such that rotation of saidfirst rotary output member applies articulation motions to saidplurality of articulation members; a firing drive member operablycoupled to said firing shaft and being configured to interface with saidsecond rotary output member to apply firing control motion to saidfiring shaft; and a closure clutch assembly operably interfacing withsaid elongate shaft assembly and said third rotary output member toreceive a third rotary output motion therefrom to thereby selectivelyaxially advance at least a portion of said elongate shaft assembly alongsaid longitudinal tool axis to apply said jaw control motions to atleast one of said first and second jaws.
 2. The surgical system of claim1, wherein said first rotary output member is configured to rotate abouta first rotary axis and said second rotary output member is configuredto rotate about a second rotary axis and wherein at least one of saidfirst and second rotary axes is transverse to said longitudinal toolaxis.
 3. The surgical system of claim 1, wherein said articulationtransmission comprises a converter configured to receive a rotary motionfrom said first rotary output member and convert said rotary motion toaxial motions applied to said plurality of articulation members.
 4. Thesurgical system of claim 3, wherein said firing drive member comprises:a firing rack gear operably interfacing with said firing shaft; and afiring gear assembly operably interfacing with said firing rack gear andsaid second rotary output member such that rotation of said secondrotary output member causes said firing gear assembly to axially drivesaid firing rack gear and said firing shaft.
 5. The surgical system ofclaim 1, wherein said first and second rotary output members areoperably supported by a housing and wherein said surgical system furthercomprises: a tool mounting portion operably coupled to said elongateshaft assembly and configured to be releasably coupled to said housing,said tool mounting portion rotatably supporting said firing drive memberthereon in operational engagement with said firing shaft; and a rotarydrive transmission in operable engagement with said firing drive memberand said second rotary output member.
 6. The surgical system of claim 5,wherein said rotary drive transmission further comprises: a rotary drivegear rotatably supported on said tool mounting portion; and a firstrotary driven gear in meshing engagement with said rotary drive gear andsaid firing drive member.
 7. The surgical system of claim 5, whereinsaid elongate shaft assembly comprises: an outer shaft assemblycomprising a distal end operably coupled to said surgical end effectorand a proximal end rotatably supported on said tool mounting portion forselective rotation about said longitudinal tool axis relative thereto,said outer shaft assembly operably supporting said firing shaft; and arotational transmission assembly operably supported on said toolmounting portion and configured to operably interface with a fourthrotary output member to receive a fourth rotary output motion therefromto thereby selectively rotate said elongate shaft assembly about saidlongitudinal tool axis.
 8. The surgical system of claim 7, wherein saidrotational transmission assembly comprises: a rotation drive gearoperably interfacing with said fourth rotary output member; a rotationdriven gear in meshing engagement with said rotation drive gear; and arotation gear on said outer shaft assembly and in meshing engagementwith said rotation driven gear and wherein said fourth rotary outputmember rotates about a fourth rotary output axis that is transverse tosaid longitudinal tool axis such that rotation of said fourth rotaryoutput member about said fourth rotary output axis rotates said outershaft assembly and said surgical end effector about said longitudinaltool axis.
 9. The surgical system of claim 8, wherein said outer shaftassembly comprises: a proximal outer shaft member; and a distal outershaft member movably coupled to said proximal outer shaft member forselective articulation relative thereto about an articulation axis thatis transverse to said longitudinal tool axis.
 10. The surgical system ofclaim 1, wherein said elongate shaft assembly further comprises: aproximal outer shaft member; and a distal outer shaft member movablycoupled to said proximal outer shaft member for selective articulationrelative thereto about an articulation axis that is transverse to saidlongitudinal tool axis.
 11. The surgical system of claim 10, whereinsaid closure clutch assembly is operably coupled to said proximal outershaft member to selectively axially advance said proximal outer shaftmember and said distal outer shaft member along said longitudinal toolaxis to apply said jaw control motions to at least one of said first andsecond jaws.
 12. The surgical system of claim 1, wherein said thirdrotary output member rotates about a third rotary output axis that istransverse to said longitudinal tool axis and wherein said closureclutch assembly comprises: a shifter rack gear coupled to said elongateshaft assembly; and a shifter drive gear operably interfacing with saidshifter rack gear and being configured to operably interface with saidthird rotary output member such that rotation of said third rotaryoutput member causes said shifter drive gear to drive said shifter rackgear axially.
 13. The surgical system of claim 11, wherein said thirdrotary output member rotates about a third rotary output axis that istransverse to said longitudinal tool axis and wherein said closureclutch assembly comprises: a shifter rack gear coupled to said proximalouter shaft member; and a shifter drive gear operably interfacing withsaid shifter rack gear and being configured to operably interface withsaid third rotary output member such that rotation of said third rotaryoutput member causes said shifter drive gear to drive said shifter rackgear axially.
 14. The surgical system of claim 1, wherein said surgicalstaple cartridge is removably supported in one of said first and secondjaws and supports therein a plurality of said surgical staples.
 15. Thesurgical system of claim 14, wherein said firing member comprises atissue cutting surface and is configured to eject said surgical staplesfrom said surgical staple cartridge as said firing member is axiallydriven in a distal direction through said surgical end effector.